The Effect of Race, Sex, and Insurance Status on Time-to-Listing Decisions for Liver Transplantation
Fair allocation of organs to candidates listed for transplantation is fundamental to organ-donation policies. Processes leading to listing decisions are neither regulated nor understood. We explored whether patient characteristics affected timeliness of listing using population-based data on 144,507...
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| Format: | Article |
| Language: | English |
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Wiley
2010-01-01
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| Series: | Journal of Transplantation |
| Online Access: | http://dx.doi.org/10.1155/2010/467976 |
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| _version_ | 1832562605639598080 |
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| author | Cindy L. Bryce Chung-Chou Ho Chang Derek C. Angus Robert M. Arnold Maxwell Farrell Mark S. Roberts |
| author_facet | Cindy L. Bryce Chung-Chou Ho Chang Derek C. Angus Robert M. Arnold Maxwell Farrell Mark S. Roberts |
| author_sort | Cindy L. Bryce |
| collection | DOAJ |
| description | Fair allocation of organs to candidates listed for transplantation is fundamental to organ-donation policies. Processes leading to listing decisions are neither regulated nor understood. We explored whether patient characteristics affected timeliness of listing using population-based data on 144,507 adults hospitalized with liver-related disease in Pennsylvania. We linked hospitalizations to other secondary data and found 3,071 listed for transplants, 1,537 received transplants, and 57,020 died. Among candidates, 61% (n=1,879) and 85.5% (n=2,626) were listed within 1 and 3 years of diagnosis; 26.7% (n=1,130) and 95% (n=1,468) of recipients were transplanted within 1 and 3 years of listing. Using competing-risks models, we found few overall differences by sex, but both black patients and those insured by Medicare and Medicaid (combined) waited longer before being listed. Patients with combined Medicare and Medicaid insurance, as well as those with Medicaid alone, were also more likely to die without ever being listed. Once listed, the time to transplant was slightly longer for women, but it did not differ by race/ethnicity or insurance. The early time period from diagnosis to listing for liver transplantation reveals unwanted variation related to demographics that jeopardizes overall fairness of organ allocation and needs to be further explored. |
| format | Article |
| id | doaj-art-62e97e73116646e185e6d3e13129b2fd |
| institution | Kabale University |
| issn | 2090-0007 2090-0015 |
| language | English |
| publishDate | 2010-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Transplantation |
| spelling | doaj-art-62e97e73116646e185e6d3e13129b2fd2025-02-03T01:22:10ZengWileyJournal of Transplantation2090-00072090-00152010-01-01201010.1155/2010/467976467976The Effect of Race, Sex, and Insurance Status on Time-to-Listing Decisions for Liver TransplantationCindy L. Bryce0Chung-Chou Ho Chang1Derek C. Angus2Robert M. Arnold3Maxwell Farrell4Mark S. Roberts5Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USADivision of General Internal Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USAThe Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Laboratory, Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USADivision of General Internal Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USADivision of General Internal Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USADivision of General Internal Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USAFair allocation of organs to candidates listed for transplantation is fundamental to organ-donation policies. Processes leading to listing decisions are neither regulated nor understood. We explored whether patient characteristics affected timeliness of listing using population-based data on 144,507 adults hospitalized with liver-related disease in Pennsylvania. We linked hospitalizations to other secondary data and found 3,071 listed for transplants, 1,537 received transplants, and 57,020 died. Among candidates, 61% (n=1,879) and 85.5% (n=2,626) were listed within 1 and 3 years of diagnosis; 26.7% (n=1,130) and 95% (n=1,468) of recipients were transplanted within 1 and 3 years of listing. Using competing-risks models, we found few overall differences by sex, but both black patients and those insured by Medicare and Medicaid (combined) waited longer before being listed. Patients with combined Medicare and Medicaid insurance, as well as those with Medicaid alone, were also more likely to die without ever being listed. Once listed, the time to transplant was slightly longer for women, but it did not differ by race/ethnicity or insurance. The early time period from diagnosis to listing for liver transplantation reveals unwanted variation related to demographics that jeopardizes overall fairness of organ allocation and needs to be further explored.http://dx.doi.org/10.1155/2010/467976 |
| spellingShingle | Cindy L. Bryce Chung-Chou Ho Chang Derek C. Angus Robert M. Arnold Maxwell Farrell Mark S. Roberts The Effect of Race, Sex, and Insurance Status on Time-to-Listing Decisions for Liver Transplantation Journal of Transplantation |
| title | The Effect of Race, Sex, and Insurance Status on Time-to-Listing Decisions for Liver Transplantation |
| title_full | The Effect of Race, Sex, and Insurance Status on Time-to-Listing Decisions for Liver Transplantation |
| title_fullStr | The Effect of Race, Sex, and Insurance Status on Time-to-Listing Decisions for Liver Transplantation |
| title_full_unstemmed | The Effect of Race, Sex, and Insurance Status on Time-to-Listing Decisions for Liver Transplantation |
| title_short | The Effect of Race, Sex, and Insurance Status on Time-to-Listing Decisions for Liver Transplantation |
| title_sort | effect of race sex and insurance status on time to listing decisions for liver transplantation |
| url | http://dx.doi.org/10.1155/2010/467976 |
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