Geographic disparity beyond the physical distance: Heart transplant outcomes in patients living in states without a transplant program

Abstract

Background

In the United States, outcomes of adult heart transplant are not well studied in those living in states without an active transplant program.

Methods

Adult heart transplant patients were identified using the United Network of Organ Sharing database (2014-2023). Two groups were formed: out-of-state (OOS) for those in states without a program and in-state (IS) for those with a program. The primary outcome is post-transplant survival. Secondary outcomes examine listing characteristics and patterns using the Center for Disease Control WONDER database.

Results

The OOS group (14 states) had 1,561 patients, with Nevada having the highest proportion. Fewer non-White individuals and those with government-sponsored insurance programs were in the OOS group (p < 0.05). Additionally, more patients in the OOS moved out of their primary state residence at the time of transplant (9.3% vs 2%, p < 0.01). Most patients traveled to high-volume centers in neighboring states to be listed. There was no difference in waitlist outcome (p = 0.13), but post-transplant survival was slightly higher in the OOS group (p = 0.04). Fewer patients in the OOS group were listed relative to their state population and the heart failure mortality cohort compared to those in the IS group (p < 0.01).

Conclusions

Overall, the outcomes for individuals living in states without a transplant program did not differ compared to those in states with a program. However, variations in listing characteristics and patterns suggest a potential geographical disparity. Policy changes are crucial to address these inequalities and improve access to heart transplants in states that lack a transplant program.