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    Friday, January 20, 2006

    Transplanting the Uninsured: Is lack of health insurance an impediment to transplant surgery? At least a couple of researchers think so:

    To get a clearer picture of the problem, Drazner and the other authors of "Health Insurance and Cardiac Transplantation" set out to compile data on organ transplant recipients and donors to see how many were uninsured.
    But they didn't find any nationwide data, so they relied primarily upon a database of 420 families of organ donors, known as the National Study of Family Consent to Organ Donation. Siminoff conducted it .

    In her survey of hundreds of Pennsylvania and Ohio families, 23 percent of organ donors were uninsured. She believes that a national survey would produce a number similar to that.

    But her database is not enough to make that assertion, Punch said.
    "The article … merely assumes that everyone without health insurance cannot get a transplant. They quote four references to this point, none of which offer empirical evidence to their assertion," Punch said of the paper.

    The paper just quantifies the percentage of organ donors in Ohio and Pennsylvania who are uninsured. It's thesis is that when it comes to heart transplants, the uninsured are giving more to society than they're getting back. But it's a thesis based on assumptions rather than on facts. It doesn't collect data on the number of people who are turned down for transplants and the reasons why, or even how many people with end stage heart failure are uninsured. It just assumes that everyone without health insurance is automatically denied a heart transplant, and substitutes anecdote and a Hollywood movie for hard data.

    So, the question remains. Is an uninsured patient with end stage heart disease more likely to die than an insured patient? According to the National Kidney Foundation, in any given year there are 16,000 people with end stage heart disease who qualify for a transplant, but only 10% of them get a heart. Obviously, it's a tight market. It's so tight, that if you're on a waiting list and you don't answer your pager when a heart becomes available (as happened to a patient I know), it goes to the next person on the list and you never get a second chance. Waiting times vary from transplant center to transplant center, but according to this source from the Cleveland Clinic, the national average is between 8 and 9 months. That isn't long enough to qualify for Medicare disability if the heart failure was caused by a sudden event - such as a viral infection or massive heart attack.

    But, thanks to pharmaceutical advances, many people these days with end-stage heart disease are able to live longer before turning to heart transplants. Those who do are certainly qualified for disability, and its Medicare benefits.

    There may be a widespread problem with heart transplants and the uninsured, but there's no way to tell from this study. The authors would do well to look for better sources of information than Hollywood.

    posted by Sydney on 1/20/2006 08:49:00 PM 0 comments


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