Healthcare Inspection - Liver Transplant Denial, Veterans Health Administration

VA’s Office of Inspector General was requested by Congressman John Kline to review why a veteran patient was “unable to receive a [liver] transplant through the VA system.” The patient in question had chronic hepatitis C that had progressed to the point that without a liver transplant it would almost certainly be fatal. We found that the patient was indeed “unsuccessful in obtaining approval for a VA transplant.” Two VA Transplant Centers (VATCs) did not accept the patient as a candidate for further evaluation, and on appeal, a third VATC also did not accept him as a candidate for further evaluation. Ultimately, the patient had a liver transplant at a non-VA facility. We found that each of the three reviewing VATCs made a decision based upon the clinical data presented and in a manner consistent with VHA policy. Nevertheless, we were concerned that while the appeal VATC listed the presence of a cardiac stent (which this patient had) as an absolute contraindication to liver transplantation, other VATCs do consider patients with cardiac stents. We concluded that when a patient has a condition regarded as an absolute contraindication at some but not all VATCs, the patient’s case should be evaluated by VATCs that do not view that condition as an absolute contraindication. We recommended that VHA consider whether or not changes to their review process should be made to address facility specific absolute contraindications to transplants. In response, VHA reconsidered its policy, but decided to continue its referral process as it is currently designed.