by Cameron Takmil, December 2, 2023

In the last year alone, over 42,000 transplants were performed. Yet, 17 people a day of the 100,000 people on the national transplant waiting list die without the transplant they so desperately hope for (HRSA). Those who are fortunate to survive on life-sustaining treatments will likely find themselves without a transplant due to the shortcomings of the process as a whole.

Inequalities in organ transplantation can be sourced back to the frequency in which certain populations require new transplants altogether. African Americans and Hispanics disproportionately suffer kidney failure as well as organ failure as a whole — both over one and half times more likely compared to whites. This disproportionate rate of organ failure can be attributed to increased rates of general comorbidities that stem from poor healthcare access and health education (Harvard Health). 

Dr. Jessica Kendrick, a kidney specialist and researcher at University of California, outlined the two main factors that affect African Americans (UC Health)). “The two most common factors are diabetes and hypertension,” both of which also affect African Americans disproportionately, Kendrick said. She cited socioeconomic barriers as the underlying cause for these disparities in not only African Americans but disadvantaged minority populations as a whole. Organ failure is a culmination of poor health and is much more treatable if one is well-educated on their health and has consistent primary care access — something that many cannot say they have.

Geography plays a role as well, as those who are situated in more impoverished areas will have to battle food insecurity and poor quality of diet (NPR). In turn, they are more likely to develop fatty liver and have a need for a liver transplant. But, in rural and low-affluence areas, completing the rigorous testing necessary to land on a donor list becomes a tall order. The first steps in the transplant process is often one that many fail to even reach or surpass. The extensive work-up and evaluations necessary to get on the waiting list bogs down the many who are already struggling to get their routine check-ups. In 2023, over 1,500 Americans were omitted from the transplant list due to being too sick to receive a transplant, adding on the already 50,000 that die from liver disease every year (NPR).

Costs are not limited only to the surgery itself, as post-operative care and medication can be a toll on the already struggling. Dr. Mary Simmerling, an assistant professor at Cornell University with a PhD in bioethics, highlights this in one of her pieces regarding the implications of organ transplantation. “Even if there were a sufficient supply of suitable organs for transplantation, the reality is that the uninsured, underinsured and the poor do not currently have an equal opportunity to fully realize the benefits of organ transplantation because they do not have equal access to very expensive and necessary post-transplant immunosuppressant medications,” Simmerling states. 

Even those with Medicare are not safe from these expenses as coverage for these post-transplant medications and services only lasts three years – at 80 percent (Centers for Medicare Services). With the cost of nearly 2,000 dollars a month and close to 400 dollars after Medicare, those living off minimum wage salary can expect this to eat a sizable portion of their monthly income and even eclipsing their income if they are unable to obtain coverage (Simmerling 2007).

Recently, in 2022, Medicare introduced a “Part B Immunosuppressive Drug Benefit”, which is an extension of the partial coverage that allows for one to be covered continuously. While a step in the right direction, the caveat is that this only covers the exact medication for immunosuppressants but not additional medication that help treat possible complications arising from the immunosuppressant drug regimen or from surgery (i.e. organ rejection). This is simply not enough to ensure patients won’t be run up with charges if any complications come about post-surgery. 

Sentiments around donating organs have not helped either, as many are hesitant to donate due to a myriad of reasons. A study done by a group of Case Western researchers found that African-Americans’ tendency to donate was related to their lack of trust in the healthcare system. 38.6% of the African-American participants agreed with the statement that “if doctors know I am an organ donor, they won’t try to save my life”, a sentiment that is rooted in historically poor healthcare access and education (Siminoff 2006).

Lack of access can also be attributed to poor procurement by organizations responsible for retrieving and regulating donor organs. Organ procurement organizations, OPOs, facilitate the organ donation and procurement process, making organs available for transplant. Across the board, black families that were potentially interested in donating received less information than their white counterparts, a factor that makes minority families reluctant to donate (Forbes).

Today, there are 56 OPOs, all responsible for handling their respective donor service area (Scienceline). Only until recently have OPOs been responsible for being more transparent about their efficacy and process of procurement. Some estimate that almost 30,000 organs are not correctly retrieved due to inefficiencies and shortcomings of the current systems. These same estimates project that 25,000 additional lives could be saved. Dorry Segev, a professor of surgery at Johns Hopkins, brought up the point that “some OPOs are prioritizing their organs-procured-per-donor rate, ignoring potential donors where only one organ can be procured”. This limits the amount of organs procured, limiting the access down the line for all (Scienceline).

In the words of Elizabeth Warren, “Right now, [United Network for Organ Sharing] is 15 times more likely to lose or damage an organ in transit as an airline is to lose or damage your luggage,” said the Massachusetts’ senator. “That is a pretty terrible record,” (NPR).

Under the Biden administration, promises have been made to double the budget for OPOs and organ procurement programs as a whole, but it will take time to see if that will come to fruition (USA Today).

Plenty of solutions have been proposed, ranging from organs generated stem cells to compensating donors for their donation. Unfortunately, stem cells research is decades away from providing safe and effective generated organs that can replicate the function of human organs. Small scale studies have been successful in creating “miniature” organs, but are still far from creating human-scaled organs (Mayo Clinic).

Some have brought up the potential of allowing the sale of organs, which in theory would increase the available organs for transplantation. A study done at Stanford in 2018 explored the possible implications of allowing the sale of organs, specifically kidneys. The researchers estimated that a donated kidney would equate to $75,000 and the overall value being $1.3 million when considering the extension of lifespan. According to the study, “The study’s calculations showed a positive net benefit, in monetary terms, of $12.4 billion for low-income people overall. The researchers also calculated that the number of transplants per year would increase from 17,500 to 31,000 — enough to supply kidneys for yearly additions to the waitlist.” The proportion of transplant receipts who were considered non-affluent would go from a mere six percent to 30, a fivefold increase (Scope). Nevertheless, while promising, this experiment would be difficult to translate into the real world, due to the reluctance of legislators.

The dilemmas of organ transplantation reflect the greater issues of society today, as a multitude of problems today have coalesced to create the obstacles we face today. In a country that boasts the largest GDP in the world, there should be no reason anyone has to die waiting for their new chance at life.

Bibliography

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