Does competition for transplantable hearts encourage 'gaming' of the waiting list?
Transplant centers may "game" the severity of listed patients to increase their patients' likelihood of receiving transplantable organs. Recent lawsuits allege gaming at some centers, and listing policies were modified in 1999 to clarify listing criteria. We tested for gaming and its relationship to heart transplant center competition. We found that increased competition resulted in more patients listed in the most severe illness category (p < .01), consistent with the gaming hypothesis. Gaming was mitigated after the 1999 policy change (p > .05), which suggests that the new rules were effective. Continued monitoring is warranted, given prior gaming and recent accusations.
Scanlon
Dennis P
DP
Department of Health Policy and Administration, Pennsylvania State University, University Park, USA. dpscanlon@psu.edu
Hollenbeak
Christopher S
CS
Lee
Woolton
W
Loh
Evan
E
Ubel
Peter A
PA
D016027:Heart Transplantation; D006801:Humans; D009927:Tissue and Organ Procurement; D014481:United States; D014850:Waiting Lists