Need an Organ? It Helps to Be Rich

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.

"Some [centers] have the luxury of really helping their transplant candidates to pay for the medications," she said, referring to the anti-rejection drugs that must be taken post-transplant and can sometimes cost more than the surgery itself.

The staff at the University of Michigan Transplant Center tries to help uninsured patients find a way to pay, said Dr. Jeffrey Punch, director of the transplant center. For some patients, financial assistance through Medicare or Medicaid can be arranged, although there are income limits.

"At our transplant center we have evaluated thousands of patients for liver transplantation, and we virtually never do a transplant without a plan for how it will be paid for," he said. "But we have only very rarely turned down a patient because of lack of insurance. In virtually all circumstances, the patient can arrange coverage of some sort."

However, because there is little governance over the transplant centers, it is not known how many people receive care like that at UMich or are turned away because of a lack of money, said Dr. Mark Drazner, a cardiologist at the University of Texas Southwestern Medical Center.

A Lack of Data

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.

Also, he said it is not fair to compare the ability to donate organs with the ability to receive organs.

"Donating organs has no risk, damages no party and causes no problem with any large-scale religious communities. I agree entirely that the uninsured people in our country are a huge public problem, but I disagree that this can be used to indict the practice of organ donation as unfair."

Siminoff feels a bit differently.

"From a very clinical point of view, you can ask what is the difference if the donor is dead? Except as a society we don't view dead people as garbage. People have very definite feelings about how dead bodies should be treated and what they represent," she said. "Families [of donors] can be harmed if they felt the person was desecrated or not treated with respect. It could have irreparable damage."

Looking at the Decisions

For patients like Regions, these are nominal concerns. His failing heart, and lack of health care, takes precedent. At the moment, he's not sure what he's going to do. He visits online support groups and works as a photographer when he has the energy.

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