ORGAN TRANSPLANTS: Racial Disparities In Kidney Wait
Waiting times for organ transplants are increasingly affected by race and geographical location, according to a federal report released yesterday. The Cleveland Plain Dealer reports that while transplant "patient waiting times varied dramatically depending on where they lived, ... black kidney transplant patients waited longer that whites in all" areas (Mazzolini/Davis, 6/12). The AP/Philadelphia Inquirer quotes United Network for Organ Sharing (UNOS) Director Mary Ellison as saying that because blacks are less likely to be organ donors, "the difference can be explained by biological differences between races, such as blood type and antigen makeup." Waiting times for kidneys increased 78% for whites between 1988 and 1994, compared to 98% for blacks. Ellison added that the racial disparity "does not exist for heart, lung or liver transplants." However, according to a report in the March issue of Medical Care, the gap may be caused not only by cross-matching difficulties but also "financial barriers" (Meckler, 6/12).
HHS vs. UNOS
The new report comes on the heels of HHS Secretary Donna Shalala's "decision this year to order the nation's transplant system ... to equalize patient waiting times across the country" by not focusing "on the circumstances of a patient's residence or transplant center affiliation." UNOS officials have resisted the proposed changes, with executive director Walter Graham asserting that the organization didn't think it "could devise a fairer system under the government's guidelines." Rep. Thomas Barrett (D-WI), who asked for the updated report on organ distribution, explained the contentious debate: "This is big business. There's a lot of money in this for large centers and ... small centers" (Plain Dealer, 6/12).
Standing By Their Plan
The report released yesterday was prepared by the Department of Health and Human Service's Inspector General. In a cover letter to Rep. Barrett, Inspector General June Gibbs Brown writes: "This review leads us to reemphasize the importance of the central thrust of our 1991 report -- that the national organ allocation system should focus on equity among patients, not among transplant centers; and on common medical criteria, not the circumstances of a patient's residence or transplant center affiliation. We continue to believe that the April 2, 1998, HHS rule on organ allocation moves in that direction" (release, 6/12). Health Resources and Services Administration head Dr. Claude Earl Fox said, "There are obviously a lot of reasons for the differences, and the report doesn't go into the reasons. It's particularly difficult for blacks and minorities to get [kidney] transplants. Some of that is a match problem, but some of it may be access as