The Case of the National Deceased Organ Donor Waiting List as a Measure of Equity and Equality of Access to Organ Transplantation
ICFAI Journal of Healthcare Law, Vol. 4, No. 3, pp. 15-24, 2006
13 Pages Posted: 18 Apr 2006
Unequal access to necessary, life-sustaining health care based on economic circumstances is a crucial problem in the arena of organ transplantation. Even if there were a sufficient supply of suitable organs for transplantation so that every person who needed organs could have them, we would still be faced with the reality that the uninsured, the underinsured, and the poor do not currently have an equal opportunity to fully realize the benefits of organ transplantation. This is because they do not have equal access to the immunosuppressant medications necessary to keep their immune systems from rejecting the transplanted organs. In some cases, this means that persons who would otherwise be potential transplant recipients never even make it onto the national deceased donor organ waiting list, whether by their own choice or that of their transplant program. Consequently, even if we could immediately and successfully implement measures to ensure that the poor have an equal opportunity to access suitable organs for transplantation, we would still be faced with the reality that the poor do not currently have an equal opportunity to access the necessary postoperative immunosuppressant medications to maintain their transplanted organs and fully realize the benefits of organ transplantation. Under the current systems, poverty acts as a de facto contraindication for organ transplantation. In addressing solutions to this problem of unequal access, it is important to focus on the full scope of the problem in both its pre- and post-operative aspects. The fundamental structural inequalities inherent in the larger healthcare and social systems in which organ transplantation takes place are not impartial but pose very real barriers to access based on the socio-economic status of potential organ transplant candidates. While it is true that attention should be paid to issues of unequal access to organs based on the greater advantages that wealthier transplant candidates have, the current national focus on access to organs only - and to deceased donor organs in particular - as a measure of equality of access to organ transplantation misses a larger and more pressing issue of inequality at stake in the area of transplantation: that of inequality in access to successful organ transplants.
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