News Roundup #2: Access Points in Hawai‘i, and a few other items

Hawai‘i is not just  a tropical paradise destination. Many people don’t realize that it faces some big health care challenges.  Recent closure of the two Hawaiian hospitals means either starting a new transplant program or depending on the mainland. Local news reports.

These issues were also outlined and foretold in a 2008 article in the Hawai‘i Medical Journal in a retrospective on 21 years of cardiac transplantation on the islands. The low transplant volume and its causes have created a very difficult situation with regard to resources and access.

a low volume program in Hawai‘i will not be able to generate the patient volumes necessary to approach Medicare requirements. Accordingly, federal funding for cardiac transplantation is restricted in the state. Attempts have been made to lobby Hawai‘i congressional representatives but an exception to the federal volume requirement has not been made.

The article also predicts the fallout from center closure, and though it is specific to cardiology, would perhaps cause similar consequences for others who seek transplantation:

The closure of a local program and out of state referral for cardiac transplantation will not be optimal for the treatment of patients with advanced cardiac disease in Hawai‘i. Residents who choose to return to Hawai‘i after undergoing transplantation in another state require ongoing extensive clinical support. This support can only be provided by a comprehensive regional transplant program. The closure of a cardiac transplantation program in Hawai‘i would therefore have significant impact on the care of patients who have undergone or wish to undergo heart transplantation. Similarly, access to advanced technologies will be limited without a state-based transplant program.

Moreover, the expense and upheaval of relocating for care on the Mainland presents its own undue strain for patients, not to mention the living donors who would have to travel even further as well.

Some of the doctors interviewed in the news story also co-authored this article in 2009 about Living Renal Transplants (LRT) and the motivations for living donation in Hawai‘i’s ethnically and culturally diverse population. They have even broken down the Asian demographics for Chinese, Filipino, Korean, Japanese, etc.,  largely because of the local population’s unique makeup and its proximity to the Pacific rim. It also outlines the importance of language in a multiethnic context,  as “A significant number of non-English speakers (26%) required some translation services.”

The discussion further states:

There are potential cultural barriers as well. Previous studies on Asian attitudes on living organ donation have mentioned “family apprehensions, medical care costs, and nonexistent social security” as barriers to organ donation. Andresen et al also demonstrated that asian patients in the United States had vastly different expectations with regards to medical care and organ donation. Because Hawai‘i is such a multi-cultural society, our health care system/staff are generally quite culturally-sensitive. Focus group studies on organ donation in Filipinos in Hawai‘i have indicated that 75% of comments reflected a positive awareness of cultural issues regarding organ donation. From our current study, it appeared that a number of Asian donors mentioned having strong sense of “family obligation” as a motivation toward LRT.

Such extensive coverage in a short article like this is demonstrative of how a transplant center’s physicians are acutely cognizant of their local population and its need for cultural and ethnic awareness in its clinical approaches and education of living donors. This clinical sensitivity and its availability to patients and donors may get lost in the shuffle with these closures on the horizon. It may also mean that the ability to approach potential living donors with such awareness is severely undercut. Up until the article was written, the LRT donor rates were no different that the US as a whole. As the article posits: “Perhaps these efforts to deal with educational/language barriers has allowed our donors to more readily participate in LRT.” In the absence of a transplant center that works to surmount possible barriers, time can only tell how a multiethnic, multicultural donor/recipient population like Hawai‘i will fare, but the prospect of entertaining such an outcome is still unsettling.

If you haven’t caught this one, illegal immigration and transplant access, New York Times.

First UK transplant surgeon to donate his kidney. Really, he’s the first? It’s a directed donation.

Craigslist actually works for a donor appeal? I wish there was more background associated with this story. The clip of the ad in the report looks fairly terse and I wonder why it was effective, if at all.

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