Transplantation and the issues surrounding its practice have wider implications that applied to health care in general. During the attempted health care reforms of the Clinton Administration in the early 1990s, many in the transplant community voiced what they saw as important lessons to be learned from transplantation. Among them, were the suggestions that current transplantation practice and policy could serve as a useful model in dealing with issues of scarcity, allocation, and physician advocacy roles. In addition, by meeting the goal of serving both individual and social interests, transplantation could serve as a model of rational policy emulation in health care reform.
In making the claim that transplantation is worthy of emulation it has to be presumed that organs are allocated fairly. However, the truth is that equal access to organ transplantation does not reflect reality. Often, non-medical factors are used to screen out potential transplant recipients. The role of money and the ability to pay in gaining access to transplantation ( Evans and Daniels' articles of Part Three) have been noted earlier in this volume. Additional non-medical, non-financial factors include personal health habits, psychological status, and family resources. Furthermore, it has been intensely argued within the literature that serious imbalances exist in access to transplantation with respect to race, gender, and age leading some to believe that transplantation is more a reflection of the health system's failures than a model for guiding the system's reform. Problems of disparate access to health care have long haunted American health care and they are present with respect to transplantation as well.
Despite being disproportionately represented on waiting lists for kidney transplants, African Americans are half as likely as whites to receive them