Patients' gender, race appear to affect wait for donated livers, research shows Women, Asian-Americans, Hispanics wait longer than white men, survey finds

March 05, 1998|By Jonathan Bor | Jonathan Bor,SUN STAFF

With concern mounting over the shortage of donor organs, a new study has found that the fate of Americans awaiting liver transplants may depend partly on their gender and ethnic background.

After combing through 7,422 patient records, researchers at the Johns Hopkins School of Public Health found that women, Hispanics and Asian-Americans wait longer than white men. Meanwhile, blacks and Asian-Americans were more likely to die waiting than were Caucasians.

"There's an assumption that when people donate, organs are put to the most equitable and best use," said Dr. Ann C. Klassen, an instructor in the school's department of health policy and management. "We need to understand any barriers that might inadvertently be coming up and do our best to mitigate them."

Although she found the differences troubling, Klassen said yesterday that she could only speculate on the reasons for them. Further research, for instance, might explain whether financial barriers -- such as the inability to get health coverage -- cause some groups to wait longer than others.

Researchers analyzed waiting lists and transplant recipient lists over a 27-month period from 1990 through 1992. Klassen said she could see no reason why the gender and racial differences would have changed since then, although waiting lists have grown.

Nationally, livers account for 20 percent of all organs transplanted and are the second most common organ transplanted in the United States, surpassed only by kidney. Patients on the waiting list suffer from hepatitis, cirrhosis, liver cancer and, in the case of children, a structural abnormality called biliary atresia.

The demand for organs far exceeds the supply, and many people die waiting. Last year, 376 people in Maryland waited for livers -- but only 66 people got them, according to the Transplant Resource Center of Maryland.

"The differences in numbers of waiting days by sex and race are less critical than the shortage of organs," said Marion Borowiecki, the center's executive officer.

The Hopkins study, published in today's issue of the journal Medical Care, found that women waited an average of 110 days to receive a liver -- compared with 91 days for men.

Klassen said she could think of no reason why women should wait longer than men, though some transplant experts said size might be the key determinant. Considerably more men than women donate organs. Their livers tend to be larger, and are more apt to fit inside other men.

Dr. Stephen T. Bartlett, who heads the transplant service at the University of Maryland Medical Center, said it is dangerous to squeeze a large organ inside a small cavity. "Since many of the donors are males, the likelihood of women finding an appropriate size liver is slightly less," he said.

Klassen doubted that size accounted for the disparity.

Dr. Andrew S. Klein, transplant director at Johns Hopkins Hospital, said the nationwide computer system that lists available organs doesn't specify whether the organ comes from a man or a woman.

"There's no discrimination of sex on the computer," Klein said, explaining that the database specifies blood group and weight.

The length of time people wait also depends on where they live.

The wait is longest in the mid-Atlantic states, apparently because the available organs are shared by several busy transplant centers including the University of Pittsburgh, the University of Maryland and Johns Hopkins.

That could change, however, under rules proposed by Health and Human Services Secretary Donna E. Shalala. The new rules would create one national waiting list. Organs would be offered to the sickest patients, regardless of where they live.

The chance of dying while waiting for a liver varied among ethnic groups. African-Americans were 1 1/2 times more likely to die waiting than whites, even though those receiving livers didn't wait any longer. Asian-Americans waited longer and were twice as likely to die before getting an organ.

Klassen speculated that blacks and Asian-Americans, as a group, were sicker. Blacks have higher rates of alcohol-related cirrhosis, and Asian-Americans have more liver cancer.

Bartlett agreed -- to a point.

In general, African-Americans come into the process with more diabetes, hypertension and nutritional disorders," Bartlett said. "With Asian-Americans, it's a little less clear."

Pub Date: 3/05/98

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