By Blythe Bernhard, St. Louis Post-Dispatch, Thursday, March 6, 2008

Black people with fatal lung diseases do not have equal opportunities for getting lung transplants, according to a new study.

The numbers of African-Americans on waiting lists for new organs are about half of what they should be based on the prevalence of certain lung diseases, researchers at Columbia University in New York found.

Of the 2,000 adults nationwide who get on waiting lists for lung transplants each year, about 150 are black.

Of the 77 people on the lung transplant waiting list at Barnes-Jewish Hospital, four are black. Barnes is the only hospital in the area that performs lung transplants on adults.

"Our waiting list is probably not reflective of the fatal lung disease prevalence in the African-American population, but it is reflective of who is referred to us for evaluation," said Dr. Alec Patterson, Barnes'' surgical director of lung transplants.

The reasons blacks don''t get on the transplant list as often as whites can be partly explained by differing access to health care, insurance coverage and risk factors such as diabetes and high blood pressure, the study says.

Transplant doctors also say that the makeup of the waiting list reflects whether primary care doctors and lung specialists know about transplant options and refer their patients early enough.

The researchers who conducted the national study also found that once on a waiting list, blacks were less likely to receive a transplant compared with whites.

After getting on a waiting list, 61 percent of blacks with chronic bronchitis or emphysema received transplants compared with 68 percent of whites. Blacks were also more likely to die or otherwise be removed from the lists before undergoing the surgeries.

At Barnes-Jewish, blacks on the waiting list were just as likely as whites to receive lung transplants in the last three years. About 5 percent of all lung transplants performed at Barnes-Jewish are for black patients.

The method for distributing donor lungs to patients on the waiting list changed in 2005. Before then, organs went to the people who had waited the longest. Now organs go to the sickest patients who are most likely to benefit from a transplant.

The change benefits minorities, Patterson says, who are more prone to diseases that cause lungs to fail more quickly and are less likely to get early interventions.

African-Americans suffer disproportionately from some serious diseases that affect the lungs, including sarcoidosis, which causes inflammation. Other chronic lung diseases, such as cystic fibrosis and emphysema, are more common in the white population.

At St. Louis Children''s Hospital, 10 of the 311 lung transplants performed since 1988 have been for black children.

Dr. Stuart Sweet, lung transplant director, said the biggest reason for the low number was that cystic fibrosis, the most common cause of lung transplants in children, is rare among African-Americans.

But Sweet adds that economic status remains an issue in transplantation. Pre- and post-transplant care requires a large financial and time commitment for the patients and their families. There are multiple appointments and tests, and lifestyle changes to make.

Because there are not enough organs for everyone who needs them, doctors consider which patients will be most likely to take care of themselves appropriately after a transplant.

"If you come from a poor socioeconomic status, it makes it more challenging for the family to do all the things that are required," Sweet said, while pointing out that patients from low-income families have been successful recipients of transplants.

The national study, which was published in the American Journal of Respiratory and Critical Care Medicine in January, reiterates what doctors already know, Sweet said. Populations with problems getting medical care will be less healthy.

"African-Americans have access issues to medical care, and that''s reflected in outcomes for transplantation."