- Research Objective:
Determine if disparities in the allocation of lifesaving organs, specifically the kidney and liver, exist between low and non-low socioeconomic status (SES) groups in the US.
A literature review will be conducted to examine anticipated inequalities between patients of different SES. Potential causes of the disparity will be examined, exploring the ways that each step of the allocative process may inherently generate inequities in organ allocation for different socioeconomic groups by disproportionately excluding the low socioeconomic status population from the waitlist. Potential solutions will be proposed based off of these findings.
US residents who are in need of a kidney or liver transplant will be studied, with the intention of comparing low SES patients to the non-low SES baseline.
There is significant disparity in the allocation of kidneys and livers to different SES populations in the US. The major contributors to this disparity were found to be the decreased ability for low SES patients to obtain a spot on the waitlist and the decreased ability of inter-donation service area (DSA) travel among low SES population. The increased difficulty that low SES patients experience in obtaining a spot on an organ waitlist has complex, multifactorial causes that are evident at various steps in the transplant process. Causes include the decreased likelihood of referral to a transplant center by a primary care physician and increased likelihood of having relative contraindications to organ transplantation. Three solutions are proposed to address the various causes of disparity. Implementation of practices that address health literacy should occur in the health care organizations which are critical in the allocation of organs in order to address the sociological causes of the inequity. Expanded Medicare coverage for transplant patients is also suggested, which will improve transplant outcomes in low SES patients and decrease contraindications to transplantation among this population. The final suggestion is to broaden regional sharing of donated organs to decrease geographic disparities in organ transplantation, thereby reducing the motivation for inter-DSA traveling. If implemented, these solutions will produce significant reductions in the inequity of organ allocation.
Compared to the non-low SES population, the low SES population is less likely to receive an organ transplant in the US due to practices which disproportionately discriminate against low SES patients. Major causes of disparity are the increased difficulty of obtaining a spot on the waitlist and the inability to participate in inter-DSA travel. These inequalities can be addressed by improving health literacy practices, increasing medicare coverage for transplant patients, and expanding the sharing of organs across DSAs.
Implications for Policy and Practice:
These findings will improve understanding of the inequity of the organ allocation system by revealing the significant disparities between SES populations which require addressing. This is critical because inequity in such a system has deeply impactful consequences on potential organ recipients. Additionally, indicating the probable causes of inequality at each step of the transplant process and proposing efficacious solutions will guide interventions and further research on the topic, and will prompt understanding of the ability and responsibility to reduce inequality in organ allocation.
- Key Words: Organ transplantation, allocation, socioeconomic status, healthcare, disparity