They're 10% to 20% less likely to undergo heart, liver and kidney transplantation
TUESDAY, Jan. 8 (HealthDay News) -- Americans living in small towns and rural areas are less likely to get organ transplants or be placed on waiting lists for transplants, a new study found.
The study of almost 175,000 potential transplant recipients showed that those living outside metropolitan centers "were 8 percent to 15 percent less likely to be wait-listed and 10 percent to 20 percent less likely to undergo heart, liver and kidney transplantation than patients in urban environments," the report said.
The report suggested two possible explanations for the findings: different patterns of illness in rural areas, or the difficulty of getting on a transplant list.
The second factor is probably more significant, transplant experts said.
"You can't just get listed easily," said Dr. Pang-Yen Fan, director of kidney transplantation at the University of Massachusetts Memorial Medical Center in Worcester. "It requires both medical and surgical evaluation, lots of testing, visits to a transplant center. Many of the patients we see live in a 30- to 50-mile radius of Worcester. For them, coming into Worcester is a big deal. So I don't think the results of the study are surprising."
Lack of sophistication on the part of potential transplant patients and their doctors also plays a role, said Dr. John Fung, director of transplant services at the Cleveland Clinic.
"You can look at the demographics of the [U.S.] population," Fung said. "Fifty percent of the people in metropolitan areas have a high school education or better, compared to one third in rural areas. So there can be a lack of knowledge."
The study, conducted by a group led by Dr. David A. Axelrod, assistant professor of surgery at Dartmouth Medical School in Lebanon, N.H., is published in the Jan. 9/16 issue of the Journal of the American Medical Association.
Organ transplants are often the best last hope for patients with heart, liver and kidney disease. Previous research has uncovered barriers to transplants for racial minorities, women, and patients who are poor or lack adequate health insurance, according to background information for the new study.
The new study looked at a number of factors that might affect the transplant rate but did not include education, Fung said. "Many people are not aware that a transplant is an option for them," he said. And doctors in rural areas might also not raise the possibility of a transplant, he added.
Distance is also a factor, Fung said. "If you look at the number of transplant programs, there are about 200 for kidney, 150 for heart, 100 for liver," he said. "So not every metropolitan area has a transplant program. The closer you live to a transplant program, the more likely you are to have one."
Another issue is the number of transplant centers in the United States, said Fan, who also is chairman of the United Network for Organ Sharing minority affairs committee. "It's important to have an adequate distribution of transplant centers around the country," he said. "And when you look at centers, you should not just be looking at their numbers. A center may do an important service even if it does only 20 to 30 transplants a year."
But opening more centers is not the answer, Fung said. "Quality is volume-dependent," he said. "The more of these you do, the better the results you get."
In the end, it's important for rural residents and their physicians to be aware that transplantation is an option in many cases and to take the necessary steps to be put on a waiting list, Fan said.
"Once you are on the list, you no longer are at a major disadvantage to anyone in an urban area," he said.
Detailed information about transplants is available from the United Network for Organ Sharing.
SOURCES: Pang-Yen Fan, M.D., director of kidney transplantation, University of Massachusetts Memorial Medical Center, Worcester; John Fung, M.D., director of transplant services, Cleveland Clinic; Jan. 9/16, 2008, Journal of the American Medical Association
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