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Differences in insurance, socioeconomic status and cardiovascular risk factors explained some but not all of the higher risk of death or removal from the waiting list, said Dr. Lederer.

In the post-hoc analysis, the researchers also found that Hispanics had similar outcomes to non-Hispanic blacks.

Strikingly, only 280 black and 64 Hispanic patients with COPD were put on the lung transplant waiting list in the United States during the 10-year study period. Based on what we know about COPD, we expected that twice as many black patients would have been put on the ling transplant waiting list. Our findings point to significant barriers to accessing lung transplantation for minorities, said Dr. Lederer.

For physicians, the implications of this research are clear. These findings should alert primary care physicians and pulmonologists to consider referral of black patients with COPD for transplantation at the earliest signs of advanced disease.

To protect themselves from these disparities, patients with COPD should prepare themselves for transplantation by discussing all of their treatment options with their doctor. To be eligible for lung transplantation, patients must quit smoking, use medications and oxygen as prescribed, and participate in a pulmonary rehabilitation program to increase their strength and endurance, said Dr. Lederer.

While the organ allocation system in place during the study period has been replaced with one that prioritizes patients based on the survival benefit of transplantation, Dr. Lederer cautions, the effects of poor insurance and poverty will likely still place blacks at increased risk for removal from the list or death.

The next step will be to identify the specific barriers that patients encounter, while trying to get on the waiting list for a lung transplant. Once we figure out the root of
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