By Rebecca Canino, Anne R. Links, and Fawaz Al Ammary
In the face of a growing organ donation crisis in the United States, characterized by a decline in donors and a surge in transplant waitlists, it has become increasingly clear that existing regulatory barriers impede access to critical transplant services. One solution lies in dismantling the artificial barrier of state-based medical licensure, a move that holds the potential to significantly enhance access for both donors and recipients of organ transplants. During the COVID-19 Public Health Emergency (PHE), the United States Department of Health & Human Services demonstrated flexibility by superseding state licensure mandates, thereby allowing providers with valid medical licensure in one state to care for patients in all states. This resulted in tangible improvements in outcomes for donors and recipients alike and prompted a notable surge in telemedicine usage, which not only streamlined evaluations but also mitigated the financial burdens (approximately $5000 per donor) and the logistical complexities associated with in-person consultations, particularly for out-of-state living donors.
Thus, telemedicine emerged as a game-changer during the PHE, enabling physicians to conduct donor evaluations remotely, thereby reducing costs and expediting waitlist evaluations. The benefits were multifaceted, addressing not only logistical challenges faced by the donors and patients alike, but also disparities in access to care as it removed many of the location-based challenges. Moreover, outcomes improved: even before the pandemic telemedicine was shown to enhance post-surgical care, improve adherence to treatment regimens, and boost patient satisfaction. However, advancements were short-lived during the pandemic, as regulatory flexibilities lapsed post-PHE and barriers to interstate practice were reinstated.
To retain and leverage the gains made in transplant care through telemedicine, Congress must act swiftly to enable federal reciprocity of medical licensure for transplant physicians. This approach mirrors successful legislative interventions such as the 2020 Department of Veterans Affairs rule enhancing the authority of VA health care professionals to practice medicine across state lines, providing a precedent for federal intervention in healthcare licensure. Another example is the Sports Medicine Licensure Clarity Act, which ensures practitioners can support athletes irrespective of state borders without fear of professional repercussions.
Creating and passing mandated medical licensure for transplant services would not only impact large organ donation but could potentially streamline blood donation services. One study has shown that telemedicine can serve as a convenient option for potential blood and plasma donors to avoid unnecessary travel and cost by pre-screening via telemedicine and could assist in recruiting new and younger donors to bolster blood supplies.
The imperative for federal reciprocity is clear: it ensures that patients and donors receive optimal care regardless of geographic location. By harnessing the power of telemedicine and extending licensure beyond state lines, we can dismantle barriers, enhance access, and save lives. A hybrid model of in-person and virtual care, facilitated by federal licensure reciprocity, represents the future of transplant medicine. It’s time for Congress to act boldly and decisively, ensuring equitable access to life-saving treatments for all.
Rebecca Canino, MBA is the Executive Director of Telemedicine at Johns Hopkins Health System.
Anne R. Links is Research Program Manager at Johns Hopkins University School of Medicine.
Fawaz Al Ammary MD, PhD, FAST is a Transplant Physician and Researcher at University of California Irvine School of Medicine.
