Introduction: Patient travel to attend Multi-Organ Transplant (MOT) clinics can be onerous in terms of time, travel costs, and lost wages. Frequent in-person appointments are routinely scheduled. At the onset of the COVID-19 pandemic we made changes to our healthcare practice by replacing some in-person appointments with virtual appointments. We sought to evaluate whether this change in clinical practice significantly reduced travel-related costs and estimate the relative percentage of family income spent on travel.  
Methods: Our study cohort included all heart, kidney, liver and lung transplant recipients currently followed by our program. All MOT appointments between April 1, 2020 and March 31, 2022 were reviewed. Total costs were calculated using an algorithm that included automobile, ferry, hotel, meals, and parking costs, with travel distance and time built into the costing estimates. Low, moderate and high cost estimates were projected for the number of visits and compared with after tax median household income. Income was based on 2016 census data.
Results: The study cohort included 148 (57% male) patients. There were 29 (20%) heart, 66 (45%) kidney, 51 (34%) liver and 2 (1%) lung transplant recipients who were transplanted at a median age of 4.8 years. Of the 1035 MOT appointments recorded during the study period, 194 (19%) were held virtually. The median travel distance from home to MOT clinics ranged from 3.6 kilometers (km) to 1,414 kilometers (km). Estimates for low, moderate and high median travel costs ranged from $64 to $26,670. Virtual appointments reduced costs by 70% across all costing scenarios. The range of household income spent on travel were 0.2% to 37.5% for virtual and 0.1% to 62.7% for in-person appointments, respectively.
Conclusion: Virtual appointments may lower the financial burden of travel by 70% for some families. Families may potentially spend up to 63% of their after tax income traveling to in-person MOT clinics. Travel subsidies from governmental and philanthropic programs are necessary to support travel for some families attending in-person clinics.