Fat discrimination in kidney transplants

In related news, the New York Times reports today on a study showing the higher a person’s body mass index, the less likely they are to receive a kidney transplant.

The study in question – posted online on Dec. 19 in The Journal of the American Society of Nephrology – included more than 130,000 patients registered for kidney transplantation from 1995 to 2006, and followed each as they waited for available organs. Led by lead author Dr. Dorry L. Segev, an assistant professor of medicine at Johns Hopkins assistant professor of medicine at Johns Hopkins, the team of researchers found:

After controlling for sex, ethnicity, insurance status and other variables, they found that compared with those of normal weight, the obese people were 8 percent less likely to receive a transplant, the severely obese 28 percent less likely and the morbidly obese — those with a B.M.I. over 40 — 44 percent less likely.

Article author Nicholas Bakalar suggests financial disincentives might be a play, citing that it is “known that obese patients are likely to have more complications and a worse outcome” (although he doesn’t offer up any statistics or numbers to justify this). He goes on to point out, however, “the practice is to assign organs only on the basis of how long a patient has been waiting, so such considerations should not enter into the decision.”

“There is a major organ shortage, and deciding how to allocate kidneys is difficult,” said Segev. “If the transplant community decides that patients with higher risks should have lower priority, this is something that should be formalized as public policy.”

Our commentary:

If you feel you have been denied placement on an organ transplant list or have been denied an available organ because of your weight, here are a few recourses available to you:

Get another opinion: If you feel your doctor is in error or is dispensing medical advice under bias, see another specialist.

Put on the pressure: Send written requests to your doctor, the hospital, the hospital’s administrators, its Board of Directors, the state medical board, your state and national representatives. In your letter, include detail on what was said to you, by whom and on what date. If you have written materials, include a copy. Ask the facility to provide their procedures and requirements on organ donation.

Find allies: Ask your doctor or your legislator to write a letter on your behalf. Contact your local patients rights association. Marshal your friends and family on a letter-writing campaign. You are not alone and the doctor or hospital needs to see this.

Research your condition and all known treatments for it: Not only will you understand the medical talk, but you will be more armed to recognize and combat bias in treatment plans offered.

Use the law – discrimination is illegal: Hire an attorney, or if you cannot afford one, many legal referral services offer information on how to secure free legal services or can give a referral for a non-profit association offering free legal services. Your local bar association may also provide information on free lawyer services. Don’t stop there: Contact your state medical board and even the National Department of Justice.

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