Purpose The WHO recommends equitable access to transplant, yet disparities in listing based on gender, race, and education exist in adults. There is little research on these factors in pediatric populations. A few pediatric studies demonstrate disparities in listing based on gender, ethnicity, and neurodevelopmental delay. However, prior analyses examined disparity factors individually, often in one organ type.

Methods The current study uses electronic medical records to evaluate sociodemographic and overt barriers that may impact listing in pediatric recipients. Sample includes 58 heart, 81 kidney, 64 liver transplant patients at a pediatric center (N=203); average age at transplant=8.2 yrs (SD=6.2 yrs). We are investigating how sociodemographics, substance abuse, history of abuse/neglect, psychological/social issues, immunization history, and transportation issues delay time to listing.

Results

Analyses show: (1) greater time to listing among kidney relative to heart and liver patients (both ps<.001); (2) a relationship between age and time to listing (rs=.48), strongest for heart patients; (3) longer time to listing for those w/public insurance (p=.015). No significant differences in time to listing were observed for gender, ethnicity, or race (though there were only 28 non-white patients).

Conclusions Certain delays are amenable to intervention efforts; others factors are less readily apparent, such as insurance type. Chart review of potential barriers is ongoing to utilize structural equation modeling to examine sociodemographic disparity factors as primary predictors and barriers (ex., psych risk) as mediators impacting listing delays.

CITATION INFORMATION: Steinberg E. A., Buchanan C., Wachs M., Schmiege S. Barriers and Disparities in Listing for Pediatric Solid Organ Transplant Am J Transplant. 2017;17 (suppl 3).

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