http://www.healthline.com/health-news/policy-fewer-kidney-transplants-for-unemployed-part-time-workers-082513

Good Luck Getting a Kidney if You're Unemployed or Work Part Time
Written by David Heitz

Does less money mean less compliance with treatment after a transplant operation?

New research points to something that doesn't surprise most transplant surgeons: You're far less likely to receive a kidney if you're unemployed, even if you're near death.

They say this is not a form of discrimination, but rather an issue of "non-compliance." It's economic reality, they argue.

Robert Woodward, a professor in the departments of health management and policy as well as economics at the University of New Hampshire conducted the study, along with doctors from three transplant hospitals in the Northeastern U.S. It appears this month in the journal Clinical Transplantation.

Recipient's unemployment restricts access to renal transplantation
Gurprataap S. Sandhu1,*, Muhammad Khattak2, Martha Pavlakis3, Robert Woodward4, Douglas W. Hanto3, Marcy A. Wasilewski3, Noelle Dimitri3, Alexander Goldfarb-Rumyantzev3
DOI: 10.1111/ctr.12177
http://onlinelibrary.wiley.com/doi/10.1111/ctr.12177/abstract

Abstract
Equitable distribution of a scarce resource such as kidneys for transplantation can be a challenging task for transplant centers. In this study, we evaluated the association between recipient's employment status and access to renal transplantation in patients with end-stage renal disease (ESRD). We used data from the United States Renal Data System (USRDS). The primary variable of interest was employment status at ESRD onset. Two outcomes were analyzed in Cox model: (i) being placed on the waiting list for renal transplantation or being transplanted (whichever occurred first); and (ii) first transplant in patients who were placed on the waiting list. We analyzed 429 409 patients (age of ESRD onset 64.2 ± 15.2 yr, 55.0% males, 65.1% White). Compared with patients who were unemployed, patients working full time were more likely to be placed on the waiting list/transplanted (HR 2.24, p < 0.001) and to receive a transplant once on the waiting list (HR 1.65, p < 0.001). Results indicate that recipient's employment status is strongly associated with access to renal transplantation, with unemployed and partially employed patients at a disadvantage. Adding insurance status to the model reduces the effect size, but the association still remains significant, indicating additional contribution from other factors.