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First published on May 7, 2008
American Journal of Hospice and Palliative Medicine® 2008, doi:10.1177/1049909108315914

Article

Racial/Ethnic Disparities in Liver Transplant Surgery and Hospice Use: Parallels, Differences, and Unanswered Questions

Alexander K. Smith, MD, MS1*, Daniela Ladner, MD2, and Ellen P. McCarthy, PhD, MPH3

1 Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, and Dana-Farber Cancer Institute, Boston, Massachusetts
2 Department of Surgery, Division of Transplantation, Stanford University Medical Center, Palo Alto, California
3 Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts

* To whom correspondence should be addressed. E-mail: asmith7{at}bidmc.harvard.edu.


  Abstract
Despite well-documented racial/ethnic disparities in liver transplantation and hospice enrollment, reasons for these disparities are unclear. This study was conducted to elucidate what is known and unknown about the underlying causes of racial/ethnic disparities in liver transplantation and hospice enrollment. The root causes of inequities in access to liver transplantation and hospice are as yet poorly understood. Potential contributors to differences include differences in preferences, mistrust of the health care system, geographic factors such as neighborhood, health care system factors such as access to care and managed care versus fee-for-service insurance status, and social factors such as the availability of a full time caregiver. Although the goals of care are different, by examining hospice and transplant surgery side by side in the larger context of health disparities, a number of potentially promising avenues for future research have been uncovered.


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