Med Care 1998 Mar;36(3):281-94
Comment in:
Med
Care. 1998 Mar;36(3):252-3.
Factors influencing waiting time and successful receipt of cadaveric
liver transplant in the United States. 1990 to 1992.
Klassen AC, Klassen DK, Brookmeyer R, Frank RG, Marconi K.
Department of Health Policy and Management, Johns Hopkins University
School of Hygiene & Public Health, Baltimore, MD 21205, USA.
OBJECTIVES: Despite concern about access to liver transplantation,
there has been no nationally based analysis of patients waiting for cadaveric
liver transplant. Using data from the United Network for Organ Sharing
Organ Procurement and Transplantation Network database waiting and recipient
lists, we examined the influence of medical and non-medical factors on
the length of time patients waited before transplant and whether they
survived the wait.
METHODS: The authors analyzed 7,422 entries to the waiting
list from October 1, 1990 to December 31, 1992. Using Cox Proportional
Hazard models, time to transplant was modelled by gender, nationality
and ethnicity, age, blood type, medical status (critically ill versus
non-critical), transplant number (first versus retransplant), United Network
for Organ Sharing region of the country, and three measures of local demand
and supply of organs. The risk of dying before being allocated an organ
was compared with receiving an organ using multiple logistic regression
models.
RESULTS: In addition to differences by medical status,
blood type, geographic region, and organ supply and demand, it was found
that women, Hispanic-Americans, Asian-Americans, and children waited longer
for transplant, whereas foreign nationals and repeat transplant patients
waited fewer days. The risk of dying before transplant was greater for
critically ill and repeat transplant patients, as well as for women, older
patients, Asian-Americans, and African-Americans. Children were less likely
to die, as were patients from certain blood groups and geographic regions.
CONCLUSIONS: Results confirm known patterns of waiting
list experience for liver transplant patients, but also identify factors
previously unrecognized as influencing waiting time and outcome. Potential
explanatory factors and areas for further inquiry are discussed.
PMID: 9520954 [PubMed - indexed for MEDLINE]
Med Care 1998 Mar;36(3):252-3
Comment on:
Med Care. 1998 Mar;36(3):271-80.
Med Care. 1998 Mar;36(3):281-94.
Med Care. 1998 Mar;36(3):295-306.
Med Care. 1998 Mar;36(3):307-20
The multiple and changing faces of access.
Andersen R.
Publication Types: Comment , Editorial
PMID: 9520950 [PubMed - indexed for MEDLINE]
