Livers Go to Sickest, Access for Blacks Improves

Blacks waiting for a liver transplant used to be more likely to die compared to whites. Now they have the same chance of getting a life-saving organ under a nationwide system that puts the sickest patients first, a new study found.

Racial differences disappeared when the old system was scrapped in 2002, according to the federally funded study, the first assessment of how blacks fared after the change.

“By design, we tried to make it race blind. It looks like we did,” said Dr. Richard Freeman, a transplant surgeon at Tufts University School of Medicine in Boston, who helped create the new system and was not involved in the study.

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Under the old system, which relied heavily on how long a patient spent on an official waiting list, sicker patients were passed over in favor of those waiting longer.

The system favored whites because blacks join waiting lists when they are sicker. Why isn’t clear, but blacks may get treatment later or have poor access to liver specialists.

Compared to whites, blacks on the waiting list had a 50 percent greater chance of dying or becoming too sick for transplant within three years, according to an analysis of five years of transplant records before the change. After the new system, called Model for End-Stage Liver Disease, or MELD, that difference disappeared.

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Prior research has also found racial disparities in the allocation of kidneys. UNOS is currently evaluating its system for kidneys, which is now based on waiting time, blood type and tissue type.

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Before the change, 810 blacks, or 49 percent of those on the waiting list, got transplants. Meanwhile, 10,202 whites, or 52 percent of those on the list, got transplants.

In the years after the change, 849 blacks, or 47 percent, got transplants compared to 8,492 whites, or 42 percent.

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[Editor’s Note: “Disparities in Liver Transplantation Before and After Introduction of the MELD Score,” by Cynthia A. Moylan, MD, et al.

can be read in full here.]