COST: It Isn't Always Better to Give (Organs) Than Receive

We write a lot about the economic case for health care, but this WSJ Health Blog post brought us back with a vengeance to the moral case...A Harvard research team found that the uninsured are about 20 times more likely to donate a liver or kidney than to receive one.

The study in the International Journal of Health Services found that 16.9% of organ donors in 2003 had no health insurance when hospitalized. Only 0.8% of transplant recipients were uninsured.

The study's authors (including prominent proponents of a single-payer system) say the share of uninsured donors is roughly proportionate to the total uninsured population. The Journal blog noted that donors tend to be younger adults, who are more likely to be uninsured than older people.  

But the problem is stark on the recipient side. Few medical centers will consider a patient who is uninsured and lacking financial resources a transplant candidate, the authors wrote.

The study was triggered after its lead author, Andrew Herring, then a third-year medical student, cared for a 25-year-old uninsured day laborer at Cambridge Hospital in Boston in 2005. Suffering from advanced cardiomyopathy, or a severely inflamed heart, the patient could not get on a transplant list, in part because he wouldn't have been able to pay for the expensive medications needed to support his recovery. He later died.

"What struck us was he was eligible to give but not receive an organ," says Steffie Woolhandler, the study's co-author who was Herring's supervisor at the time. "Had he been in a car accident six months before, everyone would have been willing to harvest his organs."

Life isn't fair. But health reform could make it fairer.