Should Ability to Pay
Ever Be a Consideration
in Gaining Access to
R. W. Evans
Most of us have puzzled from time to time over the complex issues associated with the payment of organ transplantation procedures. We have all been exposed to various commentaries suggesting that organ transplants are too expensive given other health care needs. 1,2,3 In addition, we have been entertained by debates concerning the experimental or therapeutic status of various organ transplant procedures. 4 In this article, I direct my attention to a single question: Should the ability to pay be a condition for gaining access to transplantation?
To answer this question, I think we must address several specific issues: (1) the problem of the medically uninsured, (2) the development of insurance coverage policies, (3) current insurer coverage policies pertaining to transplant procedures, and (4) the views of the general public concerning access to transplantation.
Today it is estimated that 37 million, or 15.5 percent of the people in the United States, are uninsured. 5 Add to this another 26 or 27 million people who are underinsured. All told, therefore, as many as 64 million people are uninsured or underinsured. This means that at least 26.1 percent of the U.S. population is at risk of not having insurance coverage for a liver or heart transplant. Kidneys, of course, are covered for over 90 percent of all U.S. cit‐____________________