Minorities, Women Wait Longer For Transplants White Men Get Donor Most Often, Study Says

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, Latinos and Asian Americans wait longer than white men. Meanwhile, blacks and Asian Americans were more likely to die waiting than were whites.

“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 Wednesday 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.

Nationally, livers account for 20 percent of all organs transplanted and are the second most common type of transplant in the United States, surpassed only by kidneys. 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.

The Hopkins study, published in Thursday’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,” Bartlett said.

Klassen doubted that size accounted for the disparity.

“Some people have talked about a body size difference,” she said. “But nationally the differences in body size between men and women were not significant enough to cause the differences in waiting time.”

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 .

That could change, however, under rules proposed by Health and Human Services Secretary Donna 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. Blacks were 1-1/2 times more likely to die waiting than whites . 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 Asians have more liver cancer.