Heart transplant listings increase since ACA implementation

Since the implantation of the Patient Protection and Affordable Care Act (ACA) in 2014, listings for heart transplants have increased by 17 percent, according to a recent analysis.

Meanwhile, listings for liver transplants and kidney transplants only increased 2 percent and 1 percent, respectively, during the same time period.

Lead researcher Guilherme H. Oliveira, MD, of Case Western Reserve University School of Medicine in Cleveland, and colleagues published their findings online in JAMA Cardiology on Aug. 3.

For this analysis, the researchers obtained data from the United Network for Organ Sharing registry and compared listings for heart, liver and kidney transplantation before and after implementation of the ACA. The “before” period lasted from Jan. 1, 2012, to Sept. 30, 2013, while the “after” period lasted from Jan. 1, 2014, to Sept. 30, 2015.

They included 25 states plus the District of Columbia that expanded their Medicaid program before 2014, and 21 states that chose not to expand Medicaid. They excluded states that expanded their Medicaid programs after Jan. 1, 2014.

During the study, solid-organ transplant listings increased by 2 percent from 88,111 to 89,961, including a 17 percent increase for heart transplants (from 5,670 to 6,607), a 2 percent increase for liver transplants (from 19,360 to 19,697) and a 1 percent increase for kidney transplants (from 63,081 to 63,657).

Organ listings increased 1.6 percent in states that expanded Medicaid and 3.0 percent in states that did not expand Medicaid. Meanwhile, heart transplant listings increased 21 percent and 12 percent, respectively; kidney transplant listings increased 2 percent and 0 percent, respectively; and liver transplants increased 1 percent and 3 percent, respectively.

Among Medicaid patients, organ listings increased 23 percent in states that expanded Medicaid and 5 percent in states that did not expand Medicaid. Meanwhile, heart transplant listings increased 22 percent and 2 percent, respectively; kidney transplant listings increased 25 percent and 8 percent, respectively; and liver transplants increased 21 percent and 1 percent, respectively.

“We believe that these data support our hypothesis that the ACA allows previously uninsured patients enhanced access to heart transplantation,” the researchers wrote. “While there has been a clear increase in the number of heart transplant listings, it is intriguing to speculate that the lack of a similar increase in the number of kidney transplant listings may reflect the effect of previously mandated federal insurance programs limited to patients with end-stage renal disease on dialysis. Similarly, the findings related to liver transplantation may result from lower incidence of liver failure because of the effectiveness of novel treatment of hepatitis C, traditionally the most common cause for liver transplantation in the United States.”

The researchers mentioned that the number of heart transplant listings also increased in non-Medicaid expansion states, so the increase may be influenced by factors other than expansion. They said the expansion might be in part due to the expansion of durable ventricular assist device programs in the U.S.

In addition, they said the expansion in heart transplants might not result in better outcomes because previous research showed patients undergoing a solid-organ transplant had lower survival rates if they had Medicaid and a low socioeconomic states.

“Finally, longer transplant lists will potentially exacerbate the donor shortage crisis, making expansion of donor pools and reexamination of organ al- location strategies even more urgent,” the researchers wrote.