McGowan Institute for Regenerative Medicine
faculty members Derek Angus, MD (pictured top), professor in Critical Care Medicine as well as Health Policy and Management at the University of Pittsburgh, and Mark Roberts, MD (pictured bottom), professor of Medicine, Health Policy and Management and Industrial Engineering and Chief of the Section of Decision Sciences and Clinical Systems Modeling in the Division of General Medicine at the University of Pittsburgh, are co-authors of a recently published Pitt School of Medicine study on how patient race, gender, and insurance status influence decisions about who will go on to receive liver transplants. The study indicates that women, blacks, and patients with Medicare who are in end-stage liver disease are less likely to be referred and evaluated for liver transplantation.
The study, which followed 144,507 patients hospitalized in Pennsylvania with liver-related conditions, sought to determine whether any potential barriers exist at the referral and listing steps in the transplantation process. The team found that 4,361 of these patients underwent transplant evaluation. Of these, 3,071 were waitlisted and 1,537 went on to transplantation. Patients were significantly less likely to undergo evaluation, waitlisting, and eventual transplantation if they were women, black, or covered by Medicare.
Disparities were especially apparent in the early stages of the process when evaluation and listing occurs – 61 percent of men were evaluated for transplantation compared to 39 percent of women; 73.8 percent of whites were evaluated compared to 8.6 percent of blacks; and 62 percent of patients with commercial insurance were evaluated compared to 4.7 percent with Medicare only.
“While our study was not designed to identify causes for these disparities, current practices for identifying and referring liver disease patients for transplantation should be made more transparent,” said Cindy L. Bryce, Ph.D., study lead author and associate professor of medicine, University of Pittsburgh. “Although we face a worsening gap in the supply and demand for organs for liver transplantation, race, gender and insurance status should not be factors that preclude patients from being evaluated for transplantation.”
Illustration: McGowan Institute for Regenerative Medicine.
University of Pittsburgh Schools of the Health Sciences Media Relations News Release (08/31/09)
Science Daily (08/31/09)
Pittsburgh Post-Gazette (09/01/09)
Abstract (American Journal of Transplantation. 2009 Sep;9(9):2092-101)