Organ donation rules raise ethical concerns
By Shawn Rhea
Here's an interesting query to add to life's big book of ethical questions: Would you donate your time and resources to an organization or cause that if you were ever in need of its services would deny you assistance?
Well, a large percentage of organ donors each year make a similar yet even more glaringly inequitable sacrifice, according to research in the Journal of American College of Cardiology.
Studying a national organ donation database, ethicists and cardiologists estimated 23 percent of donors who made their organs available for transplantation upon death were uninsured. The vast majority of those donors would not have been eligible to receive an organ, however, should they have needed one while alive. That's because under federal law a potential recipient must show the ability to pay for surgery, life-long follow-up care and anti-rejection medicines before he or she can be placed on the United Network of Organ Sharing's national wait list.
Unfortunately, financing an organ transplant out-of-pocket is prohibitive for all but the wealthiest Americans. The estimated costs for a heart transplant during the first post-operative year is $478,900, according to the health-care consulting firm Milliman USA. Liver transplant patients typically incur about $393,000 in expenses during the first year.
Since hospitals nationwide use the UNOS list to determine who's next to receive an organ, not being placed on it means almost certain death for individuals who, short of financial ability, meet every other requirement. And since minorities and the working poor are most likely among the ranks of the uninsured, such an exclusion undercuts efforts to make organ donation a process free of socio-economic and racial bias, according to Tom Mayo, a Southern Methodist University bioethicist and one of the study's authors.
"I think health-care disparities work out along socio-economic and racial lines in lots of different ways that we're just now starting to discover," said Mayo.
In their study, Mayo and other researchers advocate for a national study that would assess and document the number of Americans who each year are denied heart transplant eligibility simply on the grounds of economic status. "One of the hardest parts of our study was estimating what that number is, and before Congress can be moved (to address organ donation disparity) we need the data," Mayo explained.
The researchers also recommended legislators consider extending Medicare coverage to end stage heart failure patients who physically qualify for a transplant, but are unable to pay for it through insurance or self-financing measures. Legislators already have a model to follow. Currently, Medicare will cover the costs for kidney transplant candidates who are unable to afford surgery and follow-up care.
A bigger issue
While the study focused on heart transplants, the issue is "bigger than hearts," said Mayo.
Under-insured and uninsured Americans who are in need of livers, lungs or other life-saving organs are also at risk for being denied transplant eligibility. Mayo acknowledged that expecting the government to single-handedly foot the bill for organ transplants is unrealistic. The cardiac study estimated care for just 330 heart transplant patients would cost Medicare $190 million over the first five years. That cost would grow exponentially as more kinds of transplants were added to government-financed care.
A more realistic option would draw upon a pool of financial and service resources provided by hospitals, pharmaceutical companies, medical professionals and state and federal government.