Medicaid expansion may be linked to better kidney, liver transplant access in children
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Key takeaways:
- More patients were added to the waitlist after the Affordable Care Act was enacted.
- Before the legislation, patients on public insurance were more likely to be removed from the waitlist due to illness or death.
PHILADELPHIA — Expansion of Medicaid via the Affordable Care Act may be tied to less likelihood of transplant waitlist removal due to illness or death, a speaker here said.
The insurance program could also increase pediatric kidney waitlist additions.
“To date, preliminary work is shown that the ACA has improved general access to health care and transplantation [but] effects on pediatric implementation are not yet fully defined,” Donna C. Koo, MD, of Boston Children’s Hospital, said at the American Transplant Congress. The goal was to study was to “evaluate national trends in the insurance status of kidney and liver transplantation activity in children to extrapolate the effects of the ACA on transplantation access in pediatric patients.”
Researchers used data from the Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients from 2007 to 2022 to evaluate the impact of the ACA on kidney and liver transplants in patients aged 18 years or younger. Researchers studied national transplant trends before and after ACA implementation, and specifically focused on organ type, waitlist addition and removals, transplant procedures and type of insurance.
According to the results, more patients were added to the waitlist after passage of the ACA, but there was no significant difference in transplant rates. Overall, 853 children were added to the kidney waitlist and 716 transplants were performed annually prior to the ACA. By comparison, there were 989 waitlist additions and 703 transplants after the ACA.
Before the ACA, patients on public insurance were 1.7 times more likely to be removed from the waitlist due to illness or death compared with patients with private insurance. After the legislation, patients with public insurance were no longer more likely to be removed from the waitlist for those reasons compared to patients with private insurance. Koo and colleagues found that after the ACA a greater overall proportion of kidney waitlist additions and transplants were linked with having public insurance. Researchers found similar outcomes for liver transplant candidates.
“Future work will examine the impact of ACA adoption on a state-by-state basis, as well as account for the confounding effect of other major policy changes during our study, the introductions of the kidney allocation system ... and Share 35 Acuity Circles,” Koo said.
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Koo DC, et al. Poster 349. Presented at: American Transplant Congress; June 1-5, 2024; Philadelphia.
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