Need an Organ? It Helps to Be Rich

But after researching what it would take to have a transplant, he said that any measure taken to help the uninsured should include the enormous cost of immunosuppressant medications that people have to take for the rest of their lives after a transplant.

"The aftermath of the heart transplant, or any transplant, would cost more than the actual surgery itself," Regions said, adding that people who have reasonably good health insurance are still burdened by the cost of medication.

Plus, Siminoff noted, even having private health insurance doesn't make this issue go away.

"Health insurance comes and goes in this country, and some of the people [who receive transplants] are never able to go back to work full time and [they] lose health insurance," Siminoff said.

This sometimes forces people to stop taking the medication, putting them in the same poor health they were in before the transplant, Simmerling, the bioethicist, said.

"We really tend to think of transplants [and the organ transplant list] as different -- it's held up as this oasis of fairness and neutrality," Simmerling said. "But when you really start to look at how decisions are made it has a lot to do with socioeconomic status."

No Quick Solutions

While this is probably correct, some said the organ transplant system is no less fair than other areas of medicine or life in general. Put another way: Being poor is not easy.

"The primary source of inequity here is the failure to provide universal insurance coverage for all citizens or residents," said Norman Daniels, a professor of population ethics at the Harvard School of Public Health. "Remember, we are the only industrialized country to fail to do that."

Family law professor Timothy Jost agreed.

"It is unethical not to provide heart transplants for the poor, but only because it is unethical to deny the poor health care generally," said Jost, at the Washington and Lee University School of Law in Lexington, Va.

Drazner and the other study authors do not disagree with this notion. But they hope that the report at least spurs interest in the creation of a national registry that tracks that and other important information about donors and recipients.

"It's good to have all the players involved to address the situation and be aware of the financial aspects that need to be considered," he said.

Tom Mayo, a Southern Methodist University bioethicist who helped write the report, said the enormous cost of organ transplants means they can't be excluded from any debate on national health care. At the very least, he hopes the report will raise that concern among policymakers.

"How much of a health care budget should go into a transplant budget?" he said. "This opens the door to a much broader debate. This is an area where line drawing has been done and will continue for the indefinite future."

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