Unemployment restricts access to kidney transplants, study finds

August 20, 2013, University of New Hampshire

People in end-stage kidney failure in need of a kidney transplant are much less likely to be placed on a waiting list for a new kidney or to actually receive a new kidney once on the list if they are unemployed or work part time, according to new collaborative research from the University of New Hampshire.

"There is a strong negative association between a patient's unemployment and the likelihood of being placed on a waiting list for a , and once on the waiting list, the likelihood of receiving a ," says Robert Woodward, the Forrest D. McKerley Endowed Chair in Health Economics at the University of New Hampshire.

The researchers found that who are retired and/or disabled, working part time, or working full time are much more likely to be placed on a transplant waiting list than unemployed patients. They also are more likely to receive a transplant once placed on the list than unemployed patients. Finally, those who work full time are most likely to be both added to the transplant list and receive a kidney transplant.

The research was conducted by Woodward and researchers at the University of Pittsburgh Medical Center, University of Massachusetts Memorial Medical Center, and the Transplant Institute at Beth Israel Deaconess Medical Center. The new research is presented in the journal Clinical Transplantation in the article "Recipient's unemployment restricts access to renal transplantation."

Researchers evaluated transplant information for nearly 430,000 patients in end-stage renal disease from the U.S. Renal Data System and the United Network for Organ Sharing. Researchers investigated the of these patients in relation to the amount of time between being diagnosed with end-stage renal disease and being listed on the transplant list, and the amount of time from when the patient was listed to when s/he received a transplant.

Of the nearly 430,000 patients evaluated for a kidney transplant, about 54,000 were added to the list for a kidney transplant. And of those listed for a kidney transplant, nearly 22,000 actually received a kidney transplant.

Although this analysis did not identify why those who are unemployed experience faced restricted access to kidney transplantation, the authors suspect there may be many factors that contribute to the unwillingness of transplant centers to list and transplant poorly employed patients.

The researchers explain that a number of factors are considered when deciding to add someone to a transplant list and move forward with the transplant procedure, including whether the patient can afford the post-transplant and immunosuppressive medications. This post-transplant medical care plays an important part in the success of the transplant and survival of the patient.

"A lack of employment can lead to limited financial resources for the patient and subsequent inadequate medical care following the transplant. Transplant centers have found that patients with limited financial resources have higher rates of noncompliance with post-transplant medical care. Because noncompliance with post-transplant care is a leading cause of rejection, infection, and death, transplant centers may be more hesitant about providing access to transplants to those with limited financial resources," Woodward says.

Insurance status also may play a key role in whether access to kidney transplants is restricted to patients who are unemployed or employed part time, many of whom who may not have insurance due to their employment status. Woodward says there is significant evidence to suggest that lack of health insurance can significantly contribute to noncompliance with post-transplant medical care requirements, which might be responsible for up to 35 percent of unsuccessful transplants.

Those who rely only on Medicare also may experience restricted access to transplant services. According to the researchers, even though Medicare pays for a large portion of the cost of the required immunosuppressant medications, it does not cover non-immunosuppressant prescription drugs that transplant patients are more likely to require. As a result, many transplant centers require secondary, private insurance before a patient is considered for listing on the .

Finally, Woodward and his fellow researchers say that transplant centers could view employment status as a marker of mental and physical health status, education level, and perceived compliance by the patient with post-transplant care.

Woodward and his co-authors suggest that patients who are more likely to experience barriers to transplants based on employment status could benefit from increased interaction between patients, social workers, and other medical personnel, including case managers and financial specialists. The focus should be on continued employment and vocational rehabilitation, they said.

Explore further: Race, insurance status related to likelihood of being assessed for kidney transplantation

Related Stories

Race, insurance status related to likelihood of being assessed for kidney transplantation

July 26, 2012
Young black patients and patients without private health insurance are less likely to be assessed for a kidney transplant when they start dialysis, according to a study appearing in an upcoming issue of the Clinical Journal ...

Obese kidney failure patients receive survival benefit from transplantation

July 25, 2013
Most obese individuals with kidney failure can prolong their lives by receiving a kidney transplant, although this survival benefit is lower in severely obese individuals. That's the conclusion of a new study published in ...

Adolescent kidney transplant recipients appear to be at higher risk of transplant failure

July 29, 2013
Patients who received their first kidney transplant at ages 14 to 16 years appear to be at increased risk for transplant failure, with black adolescents having a disproportionately higher risk of graft failure, according ...

Education for kidney failure patients may improve chances living donor transplantation

March 21, 2013
Patients with kidney failure who have greater transplant knowledge and motivation are ultimately more likely to receive a kidney transplant from a living donor, according to a study appearing in an upcoming issue of the Clinical ...

African-Americans on Medicaid are far less likely to receive living kidney transplants

June 20, 2013
African-Americans with Medicaid as their primary insurance were less likely to receive a living kidney transplant (LKT) than patients with private insurance, according to a new study by researchers at Wake Forest Baptist ...

Quick physical exam can reduce wait for a transplant by half a year

August 3, 2012
(Medical Xpress) -- A one-day coordinated evaluation can significantly reduce the amount of time it takes to be put on a kidney transplant waitlist, according to a new study from Yale School of Medicine. The study appears ...

Recommended for you

Best of Last Year—The top Medical Xpress articles of 2017

December 20, 2017
It was a good year for medical research as a team at the German center for Neurodegenerative Diseases, Magdeburg, found that dancing can reverse the signs of aging in the brain. Any exercise helps, the team found, but dancing ...

Pickled in 'cognac', Chopin's heart gives up its secrets

November 26, 2017
The heart of Frederic Chopin, among the world's most cherished musical virtuosos, may finally have given up the cause of his untimely death.

Sugar industry withheld evidence of sucrose's health effects nearly 50 years ago

November 21, 2017
A U.S. sugar industry trade group appears to have pulled the plug on a study that was producing animal evidence linking sucrose to disease nearly 50 years ago, researchers argue in a paper publishing on November 21 in the ...

Female researchers pay more attention to sex and gender in medicine

November 7, 2017
When women participate in a medical research paper, that research is more likely to take into account the differences between the way men and women react to diseases and treatments, according to a new study by Stanford researchers.

Drug therapy from lethal bacteria could reduce kidney transplant rejection

August 3, 2017
An experimental treatment derived from a potentially deadly microorganism may provide lifesaving help for kidney transplant patients, according to an international study led by investigators at Cedars-Sinai.

Exploring the potential of human echolocation

June 25, 2017
People who are visually impaired will often use a cane to feel out their surroundings. With training and practice, people can learn to use the pitch, loudness and timbre of echoes from the cane or other sounds to navigate ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.