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Health Care Costs and Financing

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Study calls for reform of policies that reject candidates for cardiac transplantation due to lack of insurance or finances

Patients with end-stage heart failure currently need to have health insurance or another funding source to be considered eligible for cardiac transplantation. Yet, 23 percent of organ donors are uninsured. Thus, individuals can donate their hearts, but they would not be eligible to receive a heart transplant if they needed one, notes Laura A. Siminoff, Ph.D., of Case Western University, in a recent study supported by the Agency for Healthcare Research and Quality (HS08209).

Although the Federal government has acknowledged the inequities of the status quo, little governmental action has been taken to date. Dr. Siminoff and colleagues hope their paper will spark debate on this subject.

They suggest that, during the informed consent process, donor families be informed that organ recipients must be able to pay, especially when the potential donor is uninsured. Blacks agree to donate their organs at about half the rate of whites for a variety of reasons, including belief that the system of organ allocation in the United States is unfair. This perception may stem from the reality that blacks are less likely than whites to be insured and to be put on transplant lists.

The researchers assert that removing the present funding requirement for transplants will not only rectify an unacceptable inequity in the current system, but also has the potential to expand the overall donor pool. Members of economically disadvantaged segments of the population, including blacks, may be more willing to donate their organs if they perceive the allocation system to be equitable. Given that the Medicare program presently pays for kidney transplants in those with end-stage renal disease, a similar mechanism could be used to pay for cardiac transplantation for those with end-stage heart failure, suggest the authors.

See "Health insurance and cardiac transplantation: A call for reform," by Louise P. King, J.D., Dr. Siminoff, Dan M. Meyer, M.D., and others, in the May 2005 Journal of the American College of Cardiology 45(9), pp. 1388-1391.

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