Insurance Issues Favor Wealthier Patients Receiving Multiple Transplants

Raymond Givens MD PhD Columbia University Medical Center

Dr. Givens
(photo Seth Wenig) Interview with:
Raymond Givens MD PhD 

Columbia University Medical Center 

Medical Research: What is the background for this study? What are the main findings?

Dr. Givens: Multiple listing- i.e., simultaneous placement on multiple organ transplant waiting lists- is allowed by the United Network for Organ Sharing (UNOS). Because insurance generally does not pay for the costs of transportation between multiple centers or of temporary housing, there has been concern that the multiple-listing policy gives an unfair advantage to wealthier patients. We examined the UNOS database from 2000-2013 and identified 33,928 patients who were listed for a first-time single-organ heart transplant, 2% of whom met our definition of multiple-listing. Compared to single-listed patients, multiple-listed patients lived in ZIP codes with significantly higher median incomes, and were more likely to have private insurance and less likely to be supported by Medicaid. They were also significantly more likely to have blood type O and to live in areas with higher predicted waiting times. Despite having lower listing priority at the start of the primary listing and lower predicted mortality, the multiple-listed patients were often upgraded at secondary listing and had a higher eventual transplant rate (74.4% vs 70.2%) and lower mortality rate while listed (8.1% vs 12.2%). When the multiple-listed cohort was compared against a propensity-score-matched single-listed subset the relative rare of transplant was 3.02. There were no differences in post-transplant survival.

Medical Research: What should clinicians and patients take away from your report?

Dr. Givens: Multiple listing appears to be an effective response to long waiting times but appears to favor patients who appear to have more financial resources and are.objectively less sick. We argue that the multiple-listing policy should be heavily reconsidered.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Givens: Our study indicates an advantage of.multiple-listing for multiple-listed patients. We are.currently investigating it’s effects.upon single-listed patients. We have also preliminary confirmed an advantageous effect of multiple-listing for other solid organs.


Givens RC, Dardas T, Clerkin KJ, Restaino S, Schulze P, Mancini DM. Outcomes of Multiple Listing for Adult Heart Transplantation in the United States: Analysis of OPTN Data From 2000 to 2013. JCHF. 2015;():. doi:10.1016/j.jchf.2015.07.012.

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Raymond Givens MD PhD (2015). Insurance Issues Favor Wealthier Patients Receiving Multiple Transplants 

Last Updated on November 14, 2015 by Marie Benz MD FAAD