When I was a sophomore in high school on a random Saturday night my mom unknowingly answered a phone call that would change our lives forever. On that Saturday night my mom received a call stating that they had found a kidney that was a perfect match and she needed to get there as soon as possible for surgery. To us it was a miracle that that was even happening. Most people wait years for a match and somehow my mom had received one in just over a year of being on the list. When we arrived at the closest transplant center (which was almost a two hours drive away) we were informed of everything that would have to be done. We would have to book a hotel room for a week so my mom could recover there. Had it not been for my older sister who was able to book the room my mother would have had to walk away from a transplant simply because she could not afford it. According to The National Foundation for Transplants before being placed on the transplant list patients must show proof of funding for the procedure and “patients can be denied an organ they are matched with if they can’t afford the financial maintenance of the organ after surgery.” During the course of my moms stay we also struggled with insurance. The medicare system is extremely complicated and even though by law all dialysis patients must be covered under medicare it is an extremely lengthy and difficult process. Those who are struggling to receive medicare coverage and are not under a good private insurance may be unable to afford the cost of the procedure. This pegs the question of what exactly is the effect of socioeconomic status on transplants in America.
While there are many factors that affect the chance of an individual getting a transplant socioeconomic status is a large one. A paper written by David A. Axelrod, Nino Dzebisashvili, Mark A. Schnitzler, Paolo R. Salvalaggio, Dorry L. Segev, Sommer E. Gentry, Janet Tuttle-Newhall, and Krista L. Lentine called “The Interplay of Socioeconomic Status, Distance to Center, and Interdonor Service Area Travel on Kidney Transplant Access and Outcomes” looked out how socioeconomic status and the distance from a transplant center interplay to effect transplant access. In this paper it was found that “patients in the highest SES quartile had increased access to transplant compared with those with lowest SES, driven strongly by 76% higher likelihood of living donor transplantation.” Living donor transplants are a great option for so many people but can be much more costly. This is because two people must undergo an invasive surgery. Most of the time the recipient’s insurance will cover the donors appointments and procedures but for those struggling with the extremely complicated medicare system this may be difficult. This paper also talks about the geographical disparities caused by distance to transplant centers. It found after adjusting for baseline factors that patients closer to the center were overall more likely to receive a deceased transplant than those farther away. Distance from a transplant center creates a huge disparity for those unable to travel due to both physical and financial factors.
It is completely apparent that socioeconomic factors have an impact and that geographical factors are involved in this. In a dissertation by Lukas Gacheru “The Association Between County-Level Socioeconomic Factors and Kidney Transplant Waitlisting Disparities in the United States” this is further supported. The primary purpose of his research was “to determine whether county-level socioeconomic factors explained the differences in county kidney transplant waitlisting rates for dialysis patients.” Essentially Gacheru wanted to see if socioeconomic factors of a county such as unemployment rate, median household income, percentage of residents that reside in a rural area, education, food insecurity, and health insurance could predict the county’s kidney transplant waiting list. He found that “counties with a higher percentage of food insecurity, lower mean household income, a higher percentage of African American residents, a higher percentage of residents living in rural areas, a lower percentage of college graduates, and a higher percentage of unemployment” had lower transplant waitlist rates. Higher transplant waitlist rates were found amongst county’s with “a lower percentage of food insecurity, higher mean household income, lower proportions of African American residents, a lower percentage of residents living in rural areas, a higher percentage of college graduates, and lower unemployment rates.” Each of these factors is further explained in this paper. Food insecurity can cause overall poor health. Dialysis patients have a specific diet they must follow and if they are unable to, they may struggle to qualify for the waiting list. Lack of insurance and even type of insurance also causes a large barrier. According to Gacheru, “patients on Medicaid or without insurance were less likely to be placed on the kidney transplant list than those on private insurance.” This is extremely harmful to those who simply cannot afford private insurance. Increasing median household income rates is associated with higher kidney transplant rates. This can be explained in many ways such as patients who have to prioritize other things like paying for food and shelter. Another explanation for this was that only 21% of dialysis facilities were in high poverty areas leading to poor health outcomes. Percentage of residents living in a rural area is a factor for a multitude of reasons. It was found that rural facilities were less likely to use educational transplant materials. Poor health, geographical isolation, distance from the transplant center, and poverty were all also factors in these rural areas. Those with higher education statuses also showed better transplant outcomes. Unemployment is an included factor because it limits access to private insurance and contributes to unhealthy habits such as smoking and drinking. One recommendation that Gacheru makes to help eliminate these severe disparities is that “centers for Medicare and Medicaid reimbursement systems should address and reflect the county-level socioeconomic disparities in calculating dialysis centers’ chronic kidney care reimbursement model.” This model allows for doctors to receive bonuses for successful transplants. This would encourage health care providers to educate and assist their patients in getting on the waiting list. He also recommends that private insurance companies assess patients for the adverse effects of socioeconomic determinants of health and that managed care organizations should work with these states to create better educational opportunities.
While kidney transplantation is largely affected by socioeconomic status, so are other types of transplants. A paper by Mahmoud M Mansour, Darian Fard, Sanket D Basida, Adham E Obeidat, Mohammad Darweesh, Ratib Mahfouz, and Ali Ahmad titled “Disparities in Social Determinants of Health Among Patients Receiving Liver Transplant: Analysis of the National Inpatient Sample From 2016 to 2019” proves this. This specific paper looks at a multitude of disparities such as race, gender, and multiple socioeconomic factors. For the sake of this paper we will be focusing on socioeconomic factors. Disparities in liver transplants have been identified in many studies before and the purpose of this study was to provide an updated review on the disparities with new medical advances. They found that “the rates of transplants increased incrementally with a higher average household income.” This shows that a higher income has a correlation with higher transplant rates. It was also found that patients with private insurance had the highest likelihood of receiving a transplant followed by medicare patients. Patients with no insurance were the least likely to receive a transplant. This is a huge disadvantage to those unable to afford private insurance or unable to receive medicare. This study showed the persistence of disparities despite new medical advances. They also state that more research at the patient level is needed “to help understand the mechanisms by which these variables affect liver transplantation rates.” Patient level research is a more detailed approach that will allow researchers to determine exactly how these disparities affect patients and how they can be solved.
The medical field has come a very far way from where it used to be. New discoveries are found every day that are life changing. It is important that the field of medicine does not forget that their advances should not only be scientific but advances that promote health equality.
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