# Patterns, Processes, and Outcomes of Kidney and Liver Transplantation in an Era of Enhanced Community Care for Veterans

> **NIH VA I01** · VETERANS HEALTH ADMINISTRATION · 2021 · —

## Abstract

Background: While the VA has provided life-saving organ transplantation to Veterans for decades, critics of the
VA Transplant Program claimed that its requirement for Veterans to travel to designated VA Transplant Centers
across the nation reduced access to care. The passage of the MISSION Act by Congress in 2018 markedly
expanded the number of Veterans eligible to pursue transplantation and post-transplant care in the community.
We recently investigated where Veterans dually enrolled in VA and Medicare underwent kidney transplantation
and received post-transplant care and the association of the site of transplant care with long-term mortality. The
findings of this work suggest that the MISSION Act could substantially transform patterns and processes of VA
transplant care and unintentionally lead to adverse health outcomes following transplantation.
Significance/Impact: Characterizing the effects of the MISSION Act on VA transplantation and the factors that
influence where Veterans receive transplant care is critical to refine policies governing the VA Transplant
Program and allocation of resources to support the delivery of transplant-related care to Veterans with end-stage
kidney and/or liver disease. Our study will provide novel insights into how the MISSION Act is affecting patterns
and processes of transplant care, as well as outcomes of kidney and liver transplantation among Veterans.
Findings from this study will enable Veterans and VA providers to make evidence-based decisions on the source
of transplant care that optimizes long-term allograft function and overall survival.
Innovation: Our study will be the first to assess the impact of the MISSION Act on processes and outcomes of
kidney and liver transplant care and the only study to combine data from the Scientific Registry of Transplant
Recipients (SRTR) and the VA Corporate Data Warehouse (CDW) to characterize the effect of this legislation
on Veterans’ transplant care and outcomes.
Specific Aims. Our specific aims are to: (1) describe temporal patterns of VA and community transplant care (i.e.,
activation on the wait list, receipt of transplant, and post-transplant management) among Veterans approved for
kidney or liver transplantation before and after implementation of the MISSION Act; (2) identify patient and
system factors associated with the site Veterans are wait listed for and undergo kidney or liver transplantation
and receive post-transplant care (VA vs. community vs. dual); (3) examine the associations of site of: (a) wait
listing; (b) transplant surgery; and (c) post-transplant care with key outcomes (i.e., time on the wait list, death on
the wait list, receipt of transplant, allograft failure, and mortality) among Veterans approved for kidney or liver
transplantation; and (4) qualitatively examine key stakeholders’ (i.e., Veterans, VA providers, VA operations
leaders) perceptions of the facilitators of and barriers to Veterans’ use of VA for kidney and liver transplant car...

## Key facts

- **NIH application ID:** 10181818
- **Project number:** 1I01HX003303-01
- **Recipient organization:** VETERANS HEALTH ADMINISTRATION
- **Principal Investigator:** Steven Weisbord
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2021-05-01 → 2025-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10181818

## Citation

> US National Institutes of Health, RePORTER application 10181818, Patterns, Processes, and Outcomes of Kidney and Liver Transplantation in an Era of Enhanced Community Care for Veterans (1I01HX003303-01). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10181818. Licensed CC0.

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