Logo image
Back
Ongoing Trends in Lung Transplant Payer Mix in the United States (1997-2025)
Abstract   Peer reviewed

Ongoing Trends in Lung Transplant Payer Mix in the United States (1997-2025)

S. McKay, M. Daniel, J. Song, H. Zappacosta, P. Cho, J. White, M. Husain, D. Telesca, A. Abramov and A. Ardehali
The Journal of heart and lung transplantation, v 45(5), pp 185-186
Apr 2026
DOI: https://doi.org/10.1016/j.healun.2026.02.394

Abstract

Purpose: Lung transplantation in the United States nearly quadrupled from 1997-2024 due to improved outreach, geographic access, expanded recipient risk, donor supply, and health insurance access. We review trends in insurance payer mix among adult lung transplant recipients prior to legislated government insurance changes. Methods: We analyzed data from the United Network for Organ Sharing (UNOS) for all lung transplant recipients between 1997-2025. Primary payer types were determined at the time of transplant and classified as private insurance, Medicare, Medicaid, VA/TriCare, other government funding, other or unreported. We used cox linear regression to assess annual trends in payer share, reporting β-coefficients, which represent the degree of change in the outcome variable for every 1-unit change of the predictor variable (p<0.05). Results: From 1997 to 2025, 52,453 lung transplant recipients were identified for analysis. The proportion of lung transplant recipients on private insurance has steadily declined from 65.3% in 1997 to 34.9% in 2025 (601 vs 613; β coefficient: -1.15% [.0006]; p<0.001). At the same time, the proportion of lung transplant recipients on Medicare coverage increased substantially (Figure 1). Medicare beneficiaries were 16.5% of recipients in 1997 and 42.1% in 2025 (152 vs 738; β-coefficient: 1.20% [0.0005]; p<0.001). Those on Medicaid coverage decreased slightly, from 9.0% in 1997 to 8.6% in 2025, though changes were insignificant (83 vs 151; β-coefficient: 0.01% [0.0002]; p=.617). By 2025, public and non-private sources accounted for about half of payer coverage in lung transplantation. Conclusion: Public financing has played an every-increasing role in lung transplantation. The last 28 years demonstrates decreasing representation of private insurance and increased dependence on Medicare. Upcoming legislated changes to Medicare and Medicaid that project decreased access to these programs threaten access to transplant for nearly half of lung transplant patients.

Metrics

1 Record Views

Details

Logo image