In the United States, there are more than 123,000 people awaiting a lifesaving organ transplant. With the average wait time for donated organs ranging from four months to nearly five years, it can be hard for hospitals to determine who gets the organs and who doesn’t. One would think that a simple list showing who registered first or who is in the direst of need would suffice. However, new research has found that wealthier patients are getting the edge over sicker patients when it comes to organ transplantation.

Using the United Network for Organ Sharing (UNOS) database — a nonprofit that manages the U.S. organ transplant system under federal contract — researchers at Columbia University Medical Center in New York looked from 2000 to 2013 and found that by registering with more than one organ transplant center, patients had higher transplant rates, lower death rates while waiting, had more money, and had a better chance of being insured.

"It's an effective approach to address long waiting times and the shortage of organs available for the increasing demand among transplant candidates. But it undermines a bedrock principle of organ transplantation, which is that the sickest people should be transplanted first," lead author Dr. Raymond Givens, advanced heart failure and transplant fellow at Columbia University Medical Center, said in a press release. "We firmly believe the multiple listing policy needs to be reconsidered."

The researchers analyzed the UNOS database and looked for adult patients listed as first time, single-organ candidates for either heart, lung, liver, or kidney transplants. Thanks to an UNOS policy that allows for candidates to be listed at multiple centers at the same time, the researchers found, between 2000 and 2013, 2 percent of the 33,928 patients waiting for a heart transplant were multi-listed, 3.4 percent of the 24,633 patients waiting for a lung transplant were multi-listed, 6 percent of the 103,332 patients waiting for a liver transplant were multi-listed, and 12 percent of the 223,644 patients waiting for a kidney transplant were multi-listed.

As for the correlation between wealth and multi-listed patients, the research suggests wealthier patients are able to travel further, stay at temporary housing like hotels, and incur other costs that are not covered by health insurance, in order to get themselves onto multiple wait lists. Conversely, those on state-run Medicaid generally have lower income and may not have the ability to incur these same costs to get their names on lists at different centers in different states.

"The main issue is supply and demand," Givens said. "The need for donor organs increases yearly; the supply does not. We really need more people to volunteer to donate their organs. That would relieve a lot of the strain on these inequalities. From a policy perspective, there is a need to redesign the system of organ allocation to ensure fairer access."