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For Release: 4 p.m. ET, January 8, 2008
Contact: Jason Aldous 603-653-1913

Rural Patients Less Likely to Receive Organ Transplants

Dr. David Axelrod
Dr. David Axelrod

HANOVER, NH—Patients in small towns and isolated rural areas have lower organ transplant rates than patients in urban areas, according to a Dartmouth-led study in the in the January 9/16 Journal of the American Medical Association (JAMA).

The study's lead author, Dr. David A. Axelrod, and colleagues assessed the impact of rural residence on waiting list registration for heart, liver, and kidney transplant and rates of transplantation among wait-listed candidates. A total of 174,630 patients who were wait-listed and who underwent heart, liver or kidney transplantation between 1999 and 2004 were included in the study.

Axelrod is section chief of solid organ transplantation at Dartmouth-Hitchcock Medical Center (DHMC), and assistant professor of community and family medicine at Dartmouth Medical School (DMS). Co-authors included Dr. Michael Chobanian, Dr. Samuel Finlayson, of Dartmouth-Hitchcock Medical Center (DHMC) and Dartmouth Medical School, and Dr. David Goodman, of Dartmouth Medical School and the Dartmouth Institute for Health Policy and Clinical Practice. Other authors included Dr. Robert M. Merion, Dr. Robert Schaubel, and Mary K. Guidinger, of the University of Michigan.

Organ transplantation offers the best, and often only, hope for long-term survival for patients with end-stage heart, liver and kidney disease. However, despite federal regulation and national efforts to ensure equal access to the limited pool of donated organs, previous research has demonstrated the presence of significant barriers to access to transplantation services for racial minorities, women, and patients with low socioeconomic status or poor insurance, according to background information in the article. Rural residents represent another group that may have impaired access to transplant services.

Nearly 14 percent of the US population lives outside major urban areas. The researchers found significant disparities in access to organ transplantation between rural and urban populations.

Patients living in small towns and isolated rural regions were ... less likely to undergo heart, liver and kidney transplan- tation than patients in urban environments.

—Dr. David Axelrod

"This study demonstrates that patients living in small towns and isolated rural regions were 8-15 percent less likely to be wait-listed and 10-20 percent less likely to undergo heart, liver and kidney transplantation than patients in urban environments," Axelrod said.

The authors suggest these discrepancies may be related to differences in the burden of disease in rural environments or reduced access to entering the waiting list. They also warn that the increasing concentration of transplant services in high-volume urban centers may lead to increased access barriers for rural patients.

"Further assessment of the disease burden facing rural residents and the barriers in access to specialty care services is needed to ensure equitable access to life-saving organ transplants," Axelrod said.


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