Heart Transplants:

Concerns About Cost, Access, and Availability of Donor Organs

HRD-89-61: Published: May 3, 1989. Publicly Released: May 17, 1989.

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Pursuant to a congressional request, GAO reviewed heart transplantation issues, focusing on: (1) the number of hospitals performing heart transplants; (2) medical and financial criteria used in selecting transplant candidates; (3) characteristics of recipients; and (4) transplant charges and sources of payment.

GAO found that: (1) the number of hospitals with heart transplant programs increased from 12 in 1983 to 131 in 1988; (2) in 1986, Congress required, as a condition for Medicare and Medicaid reimbursement, that heart transplant hospitals become members of the Organ Procurement and Transplantation Network, which matches donor organs with potential recipients; (3) Network membership criteria are based primarily on surgeon experience; (4) in 1986, the Task Force on Organ Transplantation recommended that heart transplant hospitals perform at least 12 procedures per year, but 69 of the 131 Network hospitals performed less than 12 transplants and 22 did not perform any in fiscal year 1988; (5) although 109 hospitals performed 1,529 transplants in fiscal year 1988, over 900 patients were waiting for a transplant due to a shortage of donor hearts; (6) of the patients not accepted into the transplant programs surveyed, 90 percent did not meet medical criteria, and 7 percent did not meet financial criteria; (7) most transplant recipients were white, male, and over 45 years old; (8) the average heart transplant charge for 1987 was about $115,000; and (9) private health insurance covered most heart transplant costs.

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