ACCESS TO HEART AND LIVER-TRANSPLANTATION IN THE LATE 1980S

Because of a shortage of usable organs, many who require heart or live r transplants for survival will not have access to them. Access to car e may reflect demographic factors and ability to pay, as well as medic al considerations. Receipt of an organ may be influenced by expected s urvival with and without a transplant, age, gender, race, ability to p ay, and distance to a transplant center. Discharge abstract data from a national sample of over 500 hospitals in 1986 and 1987 were used to select heart and liver recipients and others with end-stage diseases w ho did not receive a transplant. Multivariate logistic regression anal yses were then used to estimate how receipt of a transplant was influe nced by expected years of survival after transplantation (YAT), expect ed ability to pay, age, sex, race, and distance to a transplant center . Controlling for differences in expected YAT, age, sex, race, and dis tance to the transplant center, those expected to have the most abilit y to pay were more likely to receive heart and liver transplants, comp ared to those expected to have medium ability to pay. Third-party cove rage was particularly important in receipt of a transplant for those w ith absolute contraindications. Expected YAT and age were significant, with some evidence of a tradeoff between urgency and expected YAT in the case of hearts. Men were more likely to obtain heart transplants a nd women were more likely to get liver transplants. The effect of dist ance were small. Existing regularly incentives and biological, medical , and cultural reasons may justify the age-, sex-, race-, and prognosi s-related differences in the odds of receiving a transplant. The impor tance of ability to pay may not have been adequately observed in previ ous studies restricted to the patients screened at major transplant ce nters. Hospital discharge records with personal identifiers, linkage t o official waiting lists, and better patient level socioeconomic infor mation would permit more definitive analysis.