title: Health insurance as a requirement to undergo cardiac transplantation: a national survey of transplant program practices.
abstract: BACKGROUND
  Recent limitations in Medicaid coverage of transplantation in Arizona jeopardized transplantation of potential recipients in that state and called attention to financial barriers inherent in the present organ allocation system. Policies of cardiac transplant centers regarding insurance requirements for transplantation have not been previously assessed. We sought to determine the policies of adult cardiac transplant programs nationwide regarding insurance requirements for evaluation and listing for cardiac transplantation.
  
  
  METHODS
  From December 15, 2008 to November 16, 2010, all active adult cardiac transplant programs in the United States were surveyed regarding insurance requirements for evaluation and listing for cardiac transplantation.
  
  
  RESULTS
  Surveys were completed by 62 of 101 programs, accounting for 71% of adult cardiac transplants in 2007. Only 2% of recipients were uninsured. Insurance was required by 48% of programs to evaluate and 84% to list for transplantation. For uninsured patients, 81% of programs required a large amount of money upfront (median, $200,000; interquartile range, $10,000-$300,000) to list for transplantation and often (84%) educated patients about fundraising to acquire these resources.
  
  
  CONCLUSIONS
  Adult cardiac transplant programs generally require candidates to have adequate health insurance to undergo transplantation. Uninsured patients typically need a significant amount of money upfront to be listed for transplantation and often are advised to fundraise to gather such resources.
authors.affiliation: Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: J T
authors.initials: JT
authors.lastname: Thibodeau
authors.forename: M P
authors.initials: MP
authors.lastname: Rao
authors.forename: C
authors.initials: C
authors.lastname: Gupta
authors.forename: C R
authors.initials: CR
authors.lastname: Ayers
authors.forename: S
authors.initials: S
authors.lastname: Gupta
authors.forename: P P A
authors.initials: PP
authors.lastname: Mammen
authors.forename: D W
authors.initials: DW
authors.lastname: Markham
authors.forename: J D
authors.initials: JD
authors.lastname: Mishkin
authors.forename: P C
authors.initials: PC
authors.lastname: Patel
authors.forename: L P
authors.initials: LP
authors.lastname: King
authors.forename: M H
authors.initials: MH
authors.lastname: Drazner
mesh_terms: D002309:Cardiology / Q000191:economics / Q000592:standards; D006333:Heart Failure / Q000191:economics* / Q000601:surgery*; D016027:Heart Transplantation / Q000191:economics* / Q000592:standards; D006801:Humans; D007348:Insurance, Health; D008484:Medicaid; D017057:Medically Uninsured / Q000706:statistics & numerical data; D015233:Models, Statistical; D009927:Tissue and Organ Procurement / Q000191:economics / Q000379:methods; D014481:United States; D014850:Waiting Lists