Widening of racial, socioeconomic healthcare gap for organ transplant patients during COVID-19

Editor's Note

This study led by researchers at the University of Texas Southwestern Medical Center, Dallas, finds that although COVID-19’s effect on access to liver transplantation has been all-pervasive, minorities have been disproportionately affected—especially those with public insurance.

During the initial wave of COVID-19, organ transplantation was classified as a Centers for Medicare and Medicaid Services (CMS) Tier 3b procedure, which meant it should not be postponed.

Analyzing data on adult waitlisted organ transplant candidates from March 1 to November 30, 2020, the researchers found that:

• minorities had a greater decrease in listings (-14% vs -12% Whites) and transplants (-15% vs -7% Whites), despite a higher Model for End-Stage Liver Disease (MELD) score (23 vs 20 Whites)
• of candidates with public insurance, minorities had an 18.5% decrease in transplants (vs -8% Whites)
• large programs increased transplants, accounting for 61.5% of liver transplants (vs 53.4% pre-pandemic), but minorities had significantly fewer transplants at these programs (27.7% pandemic vs 31.7% pre-pandemic).

Though improvements in disparities in candidate listings, removals, and transplants were seen from June to August, 2020, and September to November, 2020, the adjusted odds ratio of transplant for minorities was 0.89 over the entire pandemic period.

As the pandemic persists, healthcare systems must consciously strive to identify and equitably serve vulnerable populations, the researchers say.