People who need a kidney transplant are less likely to be placed on the transplant list if they don’t have a job, according to new research from the University of New Hampshire. And if unemployed people do get on the list, they’re less likely to actually receive a new kidney.
Researchers evaluated transplant waiting list information for nearly 430,000 patients experiencing end-stage kidney failure. They found that people working full-time were the most likely to be placed on a transplant list and end up receiving a new kidney. Compared to the Americans who were looking for work, the patients who were working part-time, disabled, or retired all had a better chance of getting the transplant they needed.
“There is a strong negative association between a patient’s unemployment and the likelihood of being placed on a waiting list for a kidney transplant, and once on the waiting list, the likelihood of receiving a transplant,” Robert Woodward, the Health Economics chair at the University of New Hampshire, explained in a press release about the results.
Woodward and his fellow researchers suspect that it’s harder for unemployed Americans to get organ transplants because transplant centers are hesitant to provide that type of care to poorer people.
When evaluating whether or not to add someone to a transplant list, medical professionals typically consider whether the patient can afford all of the costs associated with the procedure, including the post-transplant care and follow-up medications. They want to make sure that the patient is likely to follow directions and take the necessary medication to ensure a successful transplant. When someone is unemployed, they’re less likely to have the financial resources to pay for all of that follow-up care, partly because they’re less likely to have insurance. So they’re a riskier bet for a transplant.
The new data falls in line with previous research on the subject. A recent study from the University of Pittsburgh found that even when researchers controlled for patients’ insurance status, unemployed people still had a harder time getting onto transplant lists than people who had jobs — suggesting that employment and financial security matter even more than access to health care.
That’s likely because even when Americans do have insurance, it doesn’t guarantee they’ll be able to afford all of the medical costs that result from a transplant. The people who rely on public health programs are often at a particular disadvantage in this area.
For example, although Medicare currently offers some drug coverage for transplant patients, it’s often not enough. Patients can get coverage for 80 percent of the cost of their required post-transplant medications for 36 months — but if they need to continue treatment after that, they’re out of luck. (Some lawmakers proposed extending the length of that coverage under Obamacare, but the policy didn’t make it into the final version of the health law.) And Medicare doesn’t cover other types of prescription drugs that transplant patients often require. Because of those constraints, many transplant centers actually require Medicare beneficiaries to prove that they have secondary, private insurance before they can get on the list to receive an organ.
There are similar issues with patients on Medicaid. When state-level Medicaid programs attempt to trim costs by slashing medication benefits, the low-income Americans in the program often get booted off transplant lists because doctors worry they won’t be able to afford their treatment on their own. In 2010, Arizona eliminated transplant coverage altogether for people on Medicaid.
According to the American Transplant Foundation, about 115,000 Americans are currently on the waiting list for a life-saving organ transplant, and the vast majority of those people need a kidney. But that figure doesn’t include all of the economically disadvantaged people who can’t make it onto the list in the first place.