Organ Transplantation in Utah

Author: Michael Hooper (QAMO ’25)
Publication Date: March, 2025.

The United States faces an acute shortage of organs, with more than 110,000 people currently on a waiting list for an organ and approximately 5,000 deaths due to organ failure annually. While the number of organ transplants across the country has grown over the years, in 2023 there were just over 46,000 transplants, meaning a large majority of patients in need of a transplant are waiting for extended periods of time for their needed organ, battling organ failure and compromised health for months or years.

One of the most important factors influencing access to organs is a patient’s geographic location. Due to the nature of needing to complete an organ transplant within a limited amount of time to increase the odds of viability of the transplanted organ, organs are sourced from within a geographic range of the transplant center. In Utah, much effort has been made by the three transplant centers – Intermountain Medical Center, the University of Utah, and Primary Children’s Hospital – to increase the number of transplants, reduce waitlist times, and improve post-transplantation patient outcomes. In 2023, 714 transplants were completed in the state, 570 new patients were added to organ waitlists, and 18 patients died while waiting for a transplant. As of July 2024, 910 patients are on organ waitlists in Utah, 767 (84%) of whom are waiting for a kidney or kidney/pancreas transplant, 81 (9%) are waiting for a liver, and 61 (7%) are waiting for a heart. The remaining patients are waiting for pancreas only or lung transplant.

Closing the gap in the shortage of organs requires increases in organ supply and new initiatives by transplant centers to maximize the efficient use of available organs. In this report, we analyze transplants in Utah for the three most transplanted organs – kidneys, livers, and hearts.


Growth in Kidney, Liver, and Heart Transplants

Figure 1 shows trends in the number of transplants, waitlist additions, and deaths on the waitlist for patients listed at the three hospitals in Utah that conduct transplants. The number of kidney, heart, and liver transplants increased by 93% from 242 to 466 between 2014 and 2023. During this time period, waitlist additions also trended upward and outpaced transplants each year. Annual deaths by waitlisted patients decreased steadily from 28 to 18 in the same time span, which is a reflection of the efforts made by transplant centers to reduce the amount of time patients spend waiting for an organ.

Figure 1. Time Trends in Kidney, Heart, and Liver Transplantation in Utah
Note: Transplants, waitlist additions, and deaths on waitlist for liver, kidney, and heart transplants/candidates for Utah residents between 2014 and 2023. Data source: Organ Procurement & Transplantation Network.

From where does this growth in the number of transplants arise? We examined kidney, liver, and heart transplants at the two largest transplant centers in Utah – Intermountain Medical Center and the University of Utah (Figure 2). These two centers complete 97.5% of transplants in Utah because transplants to children are relatively rare, meaning that Primary Children’s Hospital completes few.

Figure 2. Time Trends in Kidney, Heart, and Liver Transplants by Center


Note: Kidney, liver, and heart transplants to Utah residents completed by Intermountain Medical Center and University of Utah between 2017 and 2023. Data source: Organ Procurement & Transplantation Network.

The most commonly transplanted organ is the kidney, followed by the liver, and then the heart. Between 2017 and 2023, Intermountain Medical Center increased the number of kidney, heart, and liver transplants by 102%, 114%, and 250%, respectively. The University of Utah’s transplants for these same organs grew by 21%, 24%, and 35%. Thus, the overall growth in transplants in the state of Utah is driven primarily by expansion of Intermountain Medical Center’s kidney and liver transplant programs.

Wait Times are Down

Despite growth in the number of waitlist additions, growth in the number of transplants performed and initiatives to reduce wait times have resulted in a decrease in wait times in recent years. Both Intermountain Medical Center and the University of Utah have achieved large reductions in average time to transplant since 2019 for kidneys, livers, and hearts (Figure 3). The organ with the longest average wait time is kidney and both centers have nearly halved the wait time in months since 2019. Kidney transplant candidates waitlisted by the University of Utah could expect to wait 20 months in 2019 and now wait 11. Likewise, kidney waitlist candidates from Intermountain Medical Center could expect to wait approximately 30 months for an organ in 2019 and now wait 19. Heart wait times are now very short- between 5 and 6 months on average at both centers in 2023. Liver wait times have also decreased significantly and are now close to 7 months for both centers in 2023.

Figure 3. Average Wait Time by Center


Note: The figure displays the average July LFPR of teens aged 16 to 19 by state from 2022 through 2024. Data: Current Population Survey.

Equity: A Look at Wait Times by Insurance Payer and Race

Figure 4. Wait Times by Insurance Payer

Note: Current adult waitlist for kidney, liver, and heart transplants registered at a Utah Transplant Center Utah residents. Data source: Organ Procurement & Transplantation Network.

Figure 4 exhibits the current adult wait list for heart, liver, and kidney transplants registered at a Utah transplant center as of July 2024. The time each individual has been registered is shown, broken down by insurance (a proxy for income).

Disparities in access to transplantation and outcomes are well-documented, with socially disadvantaged populations such as low-income and minority groups typically faring worse. Here, however, we see a pretty even distribution of wait times across these demographic groups. It is relevant to note that differential reimbursement rates across insurers create an incentive for many hospitals to transplant patients with private and Medicare insurance more than Medicaid patients because Medicaid reimbursement rates are much lower. Despite these incentives, Medicaid patients in Utah generally experience similar wait times as those with other payers.

Increases in transplants and decreases in wait times reflect improvements in the transplantation system in Utah. Do these system improvements result in better patient outcomes?

Post-Transplant Survival Rates: Utah Compared with the Nation

Figure 5 presents the estimated likelihood of survival three years post-transplant for the three organs studied for Intermountain Medical Center and the University of Utah Hospital. Survival rates are obtained from the Scientific Registry of Transplant Recipients, which evaluates the performance of the nation’s transplant systems. Survival rates for patients from each center are compared to the United States as a whole. Utah’s population is demographically different and healthier than the nation; thus, Utah’s survival rates have been adjusted to remove population differences so that they are more comparable to the national numbers. Intermountain Medical Center’s 3-year survival rate outperforms the nation for two of the three organs- liver and kidney, while the University of Utah outperforms the nation in one of three organs: kidney.

Figure 5. Three-Year Survival Rates

Note: Utah resident wait times for kidney, liver, and heart at Intermountain Medical Center and the University of Utah, 2019 and 2023. Data source: Scientific Registry of Transplant Recipients.

Conclusion

In conclusion, it is clear to see that organ transplantation in the state of Utah is growing rapidly. Utah has seen tremendous growth in both the number of patients added to an organ transplant waiting list, as well as in the number of organ transplants successfully performed. Intermountain Medical Center has led much of the recent growth in transplant operations, especially with kidneys and hearts. As transplant centers in Utah continue to list more patients than ever before, the rapid growth of their transplant programs have allowed them to more than keep up with demand and significantly reduce patient wait times over the last several years. Utah medical centers have worked hard to achieve this growth while serving patients with differing income levels similarly and without compromising the quality of patient care. There is still work to be done as transplant centers in Utah seek to become a standard for medical and transplant outcomes, but the future is promising with the growth and trends that we are seeing today.