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ORLANDO -- Patients who register at multiple centers for a heart transplant tend to wait longer, but are less likely to die while waiting for a transplant, according to the results of a poster presentation here.
In fact, the patients on multiple transplant lists wait more than four times as long for a heart as those on a single center transplant list (470 days median, 95% CI 227-1,023 versus 117, 95% CI 31-378, P<0.0001), reported , of Columbia University Medical Center at the American Heart Association meeting.
Action Points
- Note that this study was presented as an abstract at a conference. These data and conclusions should be regarded as preliminary until published in a peer-reviewed journal.
Patients who ultimately end up on multiple listings wait a median of 332 days (95% CI 146-677) at their first center compared to the median 114 days (95% CI 30-371) for patients who single list. In fact, 70.3% of those who list at multiple centers ended up listing at a center with a lower waitlist time than their first center (second center median waitlist time: 105 days, 95% CI 53-153 versus first center MWT: 151 days, 95% CI 114-201, P<0.0001) .
Givens said the long wait time is a reason why patients multiple list.
"They start out at a place with a long wait time, so it doesn't save them time in terms of total time but gets them more transplants and reduces their death rate," he said in an interview with the media.
A smaller portion of patients who list at multiple centers are likely to die waiting for a heart compared to those who only list at a single center (8.1% versus 12.2%, P=0.0011), and those at multiple centers are slightly more likely to receive a heart transplant (74.4% versus 70.2%, P=0.0196).
But patients who multiple list may be able to "afford" waiting. Compared to patients who single list, they are more likely to be slightly younger (53 years, 95% CI 43-60 versus 55 years, 95% CI 45-61, P<0.0001) and male (79.4% versus 75.2%, P=0.0118).
Race and education also play a role, as patients who multiple list are more likely to be white (76.4% versus 70.7%), and be a graduate of college or graduate school (25.5% versus 20.4%) than those who single list. Not surprisingly, median adjusted gross income in the zip codes of those who list at multiple centers greatly exceeds that of those who list at single centers ($90,153, 95% CI $25,471-253,831 versus $68,986, 95% CI $19,471-$209,702, P=0.0015).
Givens said that organ availability tends to vary by region -- giving the example of the waitlist for hearts in region nine (which includes New York City) being much longer than the waitlist in region five (which includes California). He commented that the organ distribution scheme that the United Network for Organ Sharing (UNOS) uses needs to be readdressed.
"The policy hasn't really addressed that issue, but instead had just accentuated socioeconomic disparities and as such, really needs to be reexamined in terms of what can be done about it," said Givens.
Nearly 40% of multiple listing patients crossed into another region, with 73.9% seeking out a bordering region and 59.5% traveling to a region with a lower waitlist time.
But Givens emphasized that the patients are not to blame because UNOS allows this in the first place, and traveling to a place where organs are more likely to be available is a completely rational approach.
"I don't see this as gaming the system, it's patients playing within the rules of the system," he concluded. "The whole question is if rules of the system should change."
Disclosures
The authors disclosed no conflicts of interest.
Primary Source
American Heart Association
Givens R, et al "Multiple listing increases access to heart, lung, liver, and kidney transplantation" AHA 2015; Abstract 35673.