Reducing transplant evaluation costs by early identification of unsuitable patients

Many patients undergo a full transplant evaluation and are rejected for transplant on the basis of the test results. Some of these patients could be identified earlier in the evaluation process, thus reducing the cost of undergoing a full evaluation. Subjects in this study were 117 patients who had undergone a heart transplant evaluation over a 6-month period. The rates of acceptance, rejection, deferral, and those deferred and later listed were monitored: 53% were accepted, 17.1% rejected, 18.8% deferred, and a further 11.1% were deferred and then later listed. Of the group that was rejected, 45% were rejected on the basis of the cardiopulmonary exercise test and deemed too well for transplant. Other reasons for patients being rejected were obesity, psychological or social issues, and as a result of other diagnostic testing. The transplant evaluation process can be modified so that the cardiopulmonary exercise test is performed first, which would reduce the ultimate cost of a transplant evaluation from $11,330 to $680. The cardiopulmonary exercise test has become an intrinsic part of the cardiac evaluation process and is a strong indicator of a patient's suitability for transplant.