Too poor for transplant: finance and insurance issues in transplant ethics.
BACKGROUND
Donor organs are a scarce gift. Additionally, transplantation is very expensive and the United States lacks universal health insurance for all citizens. These facts combine to make personal finance and insurance some of the criteria for wait listing at US transplant centers. Previous research has shown that the poor and the uninsured (as well as women and nonwhites) are less likely to receive a transplant. Living donor candidates are also limited by the US insurance system.


OBJECTIVE
To determine the effect of finance and insurance variables on access to transplant and living donation.


METHODS
A qualitative descriptive study of ethics consultation data contained in a research registry approved by the institutional review board at California Pacific Medical Center.


METHODS
This study analyzes research registry data from a large community hospital in Northern California that serves patients from California, Oregon, and Nevada. The registry data are derived from transplant ethics consultations occurring between January 1, 2007, and June 30, 2009.


METHODS
This study explores the restriction of access to transplantation and of participation in living donation.


RESULTS
More than a quarter of all transplant ethics consultation reports described the restriction of transplant-related treatment for reasons rooted in finance or insurance. Individuals on the recipient side and on the donor side were hindered with regard to access. Insurance status and personal ability to pay significantly affect access to transplantation in the United States, and this theme is a frequent feature of ethics consultations at California Pacific Medical Center.
Laurentine
Kyle Alexander
KA
Department of Transplantation, California Pacific Medical Center, San Francisco, CA 94115, USA. kylelaurentine@gmail.com
Bramstedt
Katrina A
KA
D002140:California; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D019458:Insurance Coverage; D019520:Living Donors / Q000600:supply & distribution; D016377:Organ Transplantation / Q000191:economics* / Q000941:ethics*; D011203:Poverty