December 6, 2005

Study Addresses Health Insurance
and Heart Transplants

One in four donated hearts in the U.S. comes from uninsured people, according to a study by Southern Methodist University, University Case Western Reserve University and UT Southwestern Medical Center.

Tom Mayo, SMU bioethicist and one of the authors of the study “Health Insurance and Cardiac Transplantation: A Call for Reform,” published in the May 3 issue of the Journal of American College of Cardiology, says this figure violates a basic tenet of bioethics, the principle of justice, commonly defined in health care as the equitable allocation of resources.

“A system that derives such a substantial benefit from people who, if the tables were turned, would not qualify for a transplant for financial reasons raises serious questions of justice and the equitable allocation of life-saving medical resources,” says Mayo, director of SMU’s Maguire Center for Ethics and Public Responsibility. “You should not ask a group of people, in this case nearly one-quarter of heart donors, to contribute to a pool of resources not available to them.”

The ability to pay for a donated heart is one of the requirements for being a candidate on the United Network of Organ Sharing waiting list used by hospitals. Without health insurance, patients may be unable to pay for lifelong medications and follow-up care.

The study notes, however, that since Medicare is provided to those with end-stage renal disease allowing for kidney transplants, Medicare may also be a reasonable way to cover heart transplants in patients with end-stage heart failure. African Americans also donate their organs at about half the rate of whites, which the study’s authors attribute, at least partially, to the imbalance between donors and recipients. Removing socioeconomic factors from heart transplants, they say, may improve the rate of minority donors.

“The donation system is based on trust and an inherent faith in the equity of the organ allocation process,” says Laura A. Siminoff, professor of bioethics, oncology and family medicine at Case Western Reserve University. “It is imperative that we guarantee access to transplantation to all Americans in need.  This would strengthen our ability to request donation and help ease the organ shortage.”

Federal statistics:

• Estimated first-year cost of a heart transplant, $391,000
• 70 people a day receive an organ transplant, but another 16 die waiting
• 13 percent of the age group most likely to receive a heart transplant lacks health insurance
• 1 in 4 donated hearts comes from people who lack health insurance

“By studying a database of nearly 300 organ donors, we found that approximately         25 percent had no health insurance, suggesting that one in four donated hearts in the United States come from uninsured people,” says Dr. Mark H. Drazner, a cardiologist with UT Southwestern.

Interview subjects:

• Tom Mayo, director of SMU’s Maguire Center for Ethics and Public Responsibility, 214-768-7654

• Laura A. Siminoff, Ph.D., professor of bioethics, oncology and family medicine at Case Western Reserve University, 216-368-0669

• Dr. Mark H. Drazner, cardiologist, UT Southwestern Medical Center, 214-648-3404

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A copy of the study is available from SMU Office of News & Communications at 214-768-7650 or mmdicken@smu.edu.

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Southern Methodist University is a private university in Dallas with more than 10,000 students and offers degree programs through seven schools. More information about SMU is available at www.smu.edu.