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HEALTH POLICY

Health Insurance and Cardiac Transplantation

A Call for Reform

Louise P. King, JD^_*, Laura A. Siminoff, PhD, Dan M. Meyer, MD, Clyde W. Yancy, MD, W. Steves Ring, MD, Thomas W. Mayo, JD^|| and Mark H. Drazner, MD, MSc^_*,,_*

^_* Donald W. Reynolds Cardiovascular Clinical Research Center, University of Texas Southwestern Medical Center, Dallas, Texas
Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
^|| Dedman School of Law, Southern Methodist University, Dallas, Texas
Case Western Reserve University, Cleveland, Ohio.

Manuscript received October 6, 2004; revised manuscript received January 4, 2005, accepted January 11, 2005.

^_* Reprint requests and correspondence: Dr. Mark H. Drazner, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, Texas 75390-9047. (Email: mark.drazner{at}utsouthwestern.edu).

Cardiac transplantation is an accepted therapy for patients with end-stage heart failure (ESHF). Presently in the U.S., patients with ESHF need to have health insurance or another funding source to be considered eligible for cardiac transplantation. Whether it is appropriate to exclude potential recipients solely due to lack of finances has received considerable interest including being the subject of a recent major motion picture (John Q, New Line Cinema, 2002). However, one important aspect of this debate has been underappreciated and insufficiently addressed. Specifically, organ donation does not require the donor to have health insurance. Thus, individuals donate their hearts although they themselves would not have been eligible to receive a transplant had they needed one. By querying Siminoff’s National Study of Family Consent to Organ Donation database, we find that this situation is not uncommon as 23% of organ donors are uninsured. Herein we also discuss how the funding requirement for cardiac transplantation has been addressed by the federal government in the past, its implications on the organ donor consent process, and its potential impact on organ donation rates. We call for a government-sponsored, multidisciplinary task force to address this situation in hopes of remedying the inequities in the present system of organ allocation.

Abbreviations and Acronyms   DHHS = Department of Health and Human Services   ESHF = end-stage heart failure   ESRD = end-stage renal disease   NOTA = National Organ Transplant Act   OPTN = Organ Procurement and Transplantation Network   SES = socioeconomic status   UAGA = Uniform Anatomical Gift Act