To address this behavior, the United Network for Organ Sharing (UNOS), which governs organ allocation, initiated changes in the system. Since those changes went into effect in 1999, the researchers found, so-called transplant gaming behavior dropped off.
"Although we did not find evidence of gaming after 1999, suggesting that the new policy regulates the system effectively, the competition driving gaming still exists. We need to remain vigilant because the continued competition for scarce transplantable organs could encourage new kinds of gaming," says the study's lead author, Dennis Scanlon, Ph.D., assistant professor of health policy and administration at Penn State. The paper appears in the March/April issue of Health Affairs.
In 2003, 1,174 heart transplants were performed; 3,517 people are currently on the waiting list for a heart, according to UNOS.
Before the 1999 rule change, patients awaiting heart transplants were listed in one of two categories, with the highest priority given to those expected to live less than six months without a transplant. Generally, patients who required artificial devices to keep their heart working or who were hospitalized in an intensive care unit were automatically classified as Status 1, the highest priority. Their status did not need to be clinically verified and doctors could leave their patients on the Status 1 list as long as they wanted.
In areas with more than one heart transplant center, this left a high possibility that doctors might exaggerate their patients' conditions or even admit patients to an ICU prematurely in
Contact: Nicole Fawcett or Kara Gavin
University of Michigan Health System