How The Wealthy Skirt The Organ Waitlist

You start feeling severe abdominal pain and swelling. Soon you experience fatigue, nausea, and disorientation. You go to the doctor to ask if anything is wrong. The doctor runs tests and gives you a harrowing diagnosis: your liver is failing and you need a new one as soon as possible. Unfortunately, she tells you that there are over 11,000 people waiting for livers ahead of you on the transplant waitlist. As you count down your days left, your only option is to hope that strangers who marked themselves as organ donors pass away or decide to donate their livers.

This “you” may not always be you. It could be your mother, father, sibling, or significant other. Over twenty people die every day waiting for an organ to be available for them. One would hope that a system which dictates the outcomes of thousands of lives yearly is fair: that everyone has to wait their turn until they can get the organ that would save their lives. However, as with most systems, there are ways to get ahead of the competition.

[su_pullquote align=”right”]”[I]t takes money and knowledge… traveling can make a huge difference in how quickly you get an organ.”[/su_pullquote]In the United States, it is possible to register as an organ recipient at multiple transplant centers to be put on multiple regional waitlists. This is not practical for low-income patients, as travel, housing, and medical testing expenses are not necessarily covered by insurance. Robert Veatch, a medical ethicist at Georgetown University and a member of the United Network for Organ Sharing (UNOS) ethics committee, has stated that “it takes money and knowledge…traveling can make a huge difference in how quickly you get an organ.” The incentive to register at multiple centers is further amplified because certain geographic areas have shortages or surpluses of organs relative to other areas.

According to an article published in the New York Times, New York, despite having some of the best hospitals in the country, has a shortage of organs because people in New York donate organs less frequently compared to people in almost any other state. Due to this, the wealthy in New York and similar organ-poor areas are incentivized to fly to regions with more organs and to register at different transplant centers far from home.

Correlations between wealth, multiple registration, and waitlist-related death are firmly grounded in peer-reviewed research. A study focusing on liver transplants published by researchers at Weill Cornell Medical Center comparing 147 patients found stark differences in the incomes between those who transplanted outside their home region and those who did not. The article revealed that patients successfully getting a transplant elsewhere had higher median incomes than those who had died on the waitlist, respectively $84,946 and $55,250. The study also showed that patients with a median income of less than $60,244 had a 6% chance of living, while those with a median income higher than $60,244 had a 30% chance of living. Additionally, researchers found that 100% of the patients surveyed who were on Medicaid, a public insurance provider for low-income individuals, had passed away while on the waitlist compared to only 77% of patients who had other insurance providers.

A different study conducted by researchers at the Columbia Medical Center which surveyed 679 patients looking for heart transplants also found disparities between people who registered at multiple centers and people who did not. Those who had registered multiple times came from ZIP codes that have a median income of $90,153 while those registered once came from ZIP codes that have a median income of $68,986.

It’s hard to blame people who register for organ donation at multiple centers; anyone would do what’s necessary to increase their chances of living. However, the UNOS policy that allows people to have more than one registration undoubtedly gives the wealthy a large advantage. The cost of travel, housing, and testing prohibit those of lower socioeconomic status from registering at multiple centers. Often times, those limited to registering at one center are in worse medical conditions than those who can register at multiple centers simply due to their inability to pay for the best healthcare. The advantages given to the wealthy are very representative of profit-oriented healthcare in the United States; however, this system, unlike most, can be easily improved.

[su_pullquote]In order to create an equitable system, research studies and simple morality suggest that UNOS must either ban multiple registrations or promote the sharing of donated organs between geographic regions.[/su_pullquote]In order to create an equitable system, research studies and simple morality suggest that UNOS must either ban multiple registrations or promote the sharing of donated organs between geographic regions. As our society progresses to be more equitable to those from all socioeconomic backgrounds, we must push UNOS to recognize the ethical responsibility it has to fix the unjust process that it oversees. After all, it could be you or someone dear to you that finds out they need an organ transplant to live. Would you want anyone to have an unfair advantage in a system that determines life and death?

Salil Uttarwar ‘21 studies in the College of Arts & Sciences. He can be reached at suttarwar@wustl.edu.