August 12, 2016 Statement from Office of Public Affairs, U.S.

Department of
Veterans Affairs

Statement

The Department of Veterans Affairs (VA) is committed to providing the very best in quality
health care services to our Nations Veterans. VA provides comprehensive transplant care and
treatment to eligible and enrolled Veterans through a network of 1,055 outpatient clinics and 168
VA Medical Centers of which twelve are designated VA Transplant Centers (VATC). The VATCs
comprise the VA Transplant Program, which evaluates approximately 2,500 referrals and
performs more than 550 solid organ (heart, liver, lung, kidney) and bone marrow transplants
annually. VAs Transplant Program outcomes compare favorably to all United States Transplant
Centers as publicly reported by the Scientific Registry for Transplant Recipients (SRTR).

Background

The Veterans Health Administration provides oversight of the VA Transplant Program through
the National Surgery Office as described in VHA Directive 2012-018.

The VAs National Surgery Office (NSO) has established a secure, intranet-based system, named
TRACER, to facilitate the referral of the Veteran from a referring VA facility to the selected
VATC. TRACER also tracks the timeliness of VATC referral decision, evaluation, wait listing,
and transplant, as well as survival. The VA supports the VA Transplant Program through
telehealth and travel benefits for pre-transplant evaluation, the transplant procedure and posttransplant follow-on care, and treatment of the Veteran and living donor if applicable. Travel
benefits also apply to the Veteran's caregiver.

Published studies analyzing retrospective data show that the majority of transplant candidates,
both in and outside the VA, live considerable distances from a transplant center. The results of
these studies indicate that the time from referral to placement on the United Network of Organ
Sharing (UNOS) deceased donor organ wait list is less if the candidate lives within 100 miles of

the transplant center. For Veterans referred to the VA Transplant Program, further study would be
required to determine whether the implementation of TRACER, access to VA travel benefits, and
the utilization of telehealth have impacted the reported travel distance risk. However, it should be
noted that VA Transplant Program outcomes, including 1 and 3 year survival rates, compare
favorably to all United States Transplant Centers as publicly reported by the Scientific Registry
for Transplant Recipients (SRTR).

The VA has the authority to refer a Veteran for transplant care in the community in
the case that the VA Transplant Program is not feasibly accessible due to urgency of
the services required or a VATC cannot provide the medically necessary services
required given unique circumstances. This authority extends to the living donor as
required.

In summary, the VA Transplant Program is well established and resourced to provide

comprehensive transplant services to Veterans enrolled in the VHA. Outcomes are
favorable when compared nationally by Scientific Registry of Transplant Recipients.
When necessary, care in the community is available; however, such outsourced care
requires additional coordination of services while potentially negatively impacting
VATC utilization and efficiency.