The purpose of this study was to examine possible barriers to cardiac transplantation using data from patients with dilated or unspecified cardiomyopathy identified from the discharge listings of five metropolitan Washington, DC hospitals for the period from July 1, 1990 to February 29, 1992. Patients were interviewed by telephone. Following a baseline interview, the survival patients were re-contacted four times at approximately 1-year intervals. At the second follow-up interview, surviving patients who had not undergone cardiac transplantation were asked a series of questions about why they had not received a heart transplant.

A total of 138 eligible patients were included, of which 103 were black and 25 were white. Initial interviews were obtained from 129 (80.6%) patients. Older age, lower income, and lack of private health insurance were inversely associated with having been placed on a waiting list. In multivariate analysis, only older age was significantly associated with having been placed on a waiting list.

Black patients and those who were not married were significantly less likely to have undergone cardiac transplantation. Furthermore, only black race was significantly associated with time to cardiac transplantation. Multivariate analysis that included measures of income, education, and insurance status as well as race was not possible because these measures were highly correlated.

Patients (or surrogates of the patients) were asked why they did not undergo transplantation. Black patients were more likely to report that they were not sick enough (30% of whites and 67.5% of blacks), as were patients with income greater than $15,000 (40% of low income and 62.5% of high-income patients). However, these differences were not statistically significant. Patients on Medicaid were more likely to report that they were on a waiting list but no donor organ was available and were less likely to report that the doctor/surgeon did not recommend a transplant. With regard to race, there were no statistically significant differences, but blacks were slightly more likely to report they were not sick enough and slightly more likely to report that their doctor/surgeon did not recommend a transplant (82.5% of blacks versus 70.0% of whites).

The authors conclude that black patients with idiopathic dilated cardiomyopathy and those who are poor or lack private health insurance are considerably less likely to undergo cardiac transplantation. "The results of this study may contribute to discussions of equity in the selection of patients for cardiac transplantation." This study is limited in the scope of variables included, its reliance on self-report data of uncertain validity and reliability, and in its lack of heterogeneity with regard to a number of variables, including race/SES.