Need an Organ? It Helps to Be Rich

Brian Shane Regions is dying.

Medications sustain the 34-year-old for now, but a heart transplant is his only hope of a cure for his congestive heart failure -- as is the case for the thousands of others who suffer from irreversible heart damage.

But Regions lacks health insurance and receives inconsistent care for his condition. He said some of his doctors have casually suggested that he should be on the waiting list for a new heart, but not one has helped him pursue it.

"There's really nothing I can do," said Regions, a freelance photographer in Campti, La. "I don't have the insurance to do it right now. They are treating the symptoms. I'm managing, but I know I'm slowly getting worse and it's not going to get any better."

It's the harsh reality of the organ transplant field: Patients who are uninsured or unable to pay are sometimes denied lifesaving treatment because hospitals can't afford to foot the bill for the surgery or the extensive recovery.

And while inadequate health care is a big problem in general for uninsured Americans, organ transplants raise unique ethical issues, said the authors of a report in the Journal of the American College of Cardiology. While the uninsured or poor can't easily receive organs, they do donate them: As many as 25 percent of organs come from the uninsured, according to estimates by the authors of "Health Insurance and Cardiac Transplantation: A Call for Reform."

Or, in other words, as the report states: "Individuals donate their hearts, although they themselves would not have been eligible to receive a transplant had they needed one."

But whether the organ transplant system is fair or not depends on whom you ask.

Most bioethicists say the organ transplant system should be "equal opportunity" -- that anyone who is willing to donate should be eligible for a transplant themselves, regardless of the ability to pay. But some say the health care system is full of similar examples in which either the poor or the rich (but mostly the rich) are at an advantage and transplants are just a small part of a bigger problem.

The 'Wallet Biopsy'

To find matching donor organs, transplant centers rely on the United Network for Organ Sharing, or UNOS, a nonprofit organization that maintains a nationwide patient waiting list. Organs are then typically dispensed to the sickest patients or to those who have been waiting a long time.

UNOS maintains the list, but it's left up to 256 organ transplant centers across the United States to decide who gets on the list. Each center sets its own criteria, which often include the patient's ability to pay.

Laura Siminoff, a bioethicist, called this the "wallet biopsy," during which a person's financial standing comes under scrutiny.

"Every transplant center can do what they want," said Siminoff, who directs the bioethics program at Case Western University and is a board member of the Minority Organ Tissue and Transplant Education Program in Cleveland. "Centers have different practices. And if you're a well-to-do patient, you can shop around to centers. But if you don't have any money, you will go wherever is closest, and their policies are what you are stuck with."

Trying to Help the Poor

Thankfully, not all transplant centers turn away uninsured patients, pointed out Mary Simmerling, a bioethics fellow at the MacLean Center for Clinical Medical Ethics at the University of Chicago. She also runs a regional ethics consortium on organ transplants.

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