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Original Research
Access to Transplant Care and Services Within the Veterans Health Administration
Author disclosures The authors report no actual or potential conflicts of interest with regard to this article.
Disclaimer The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the US Government, or any of its agencies.
Dr. Gunnar is National Director of Surgery, Dr. Bronson is Chief Biostatistician, and Dr. Cupples is Director of Clinical Services, all at the National Surgery Office, Veterans Health Administration in Washington, DC. Dr. Gunnar also is a Clinical Professor of Surgery at George Washington University in Washington, DC. Correspondence: Dr. Gunnar (william.gunnar@va.gov)
The retrospective design and limited study period represent limitations. Specifically, survival outcomes for veterans transplanted were limited to 1 year and do not rule out the possibility that distance to a VATC will impact survival rates at 3 and 5 years posttransplant.
Conclusion
A referral distance of less than 100 miles from the VATC most often represents a direct referral and is a factor in timeliness of transplant initial review decision, evaluation, and placement of the veteran on the UNOS waitlist. Distance between the referring VA medical facility and the VATC, including distances of greater than 500 miles, was not found to impact the rate of mortality on the UNOS waitlist, time to transplantation, or posttransplant survival. Overall, the VHA provides timely solid organ transplant care and services with outcomes comparable to that of nationally reported SRTR estimates. Future studies should examine the timeliness of services, outcomes, and costs associated with those veterans authorized by the VHA for non-VA community care and those veterans who independently elect to receive transplant care and services by a non-VA transplant center and return to the VHA for dual care following transplantation.
