Unfortunately, the nation’s organ allocation system continues to make an already dire situation worse by creating geographic disparities in access to organs for transplant: people living in some parts of the country wait far longer and are sicker when they receive an organ than those in other parts of the country. Consequently, hundreds of Americans needlessly die every year while waiting for organs.
Under current rules, the sickest liver patients are ranked at the top of local waiting lists within their UNOS region. Organs from a deceased donor are given to the sickest person in that region, even if there are sicker patients in greater need elsewhere in the nation. In many states, this leads to far fewer organs than in other parts of the country—and far more avoidable deaths. It also enables more affluent patients needing liver transplants to get on shorter waiting lists by traveling to areas with better access to healthy organs.
Additional evidence of the ongoing disparity can be seen through the higher overall death rates in places where patients have to wait longer to receive a life-saving transplant. For patients with very high MELD scores, findings indicate a 90-day probability of waitlist death, ranging widely from 14% in some DSAs to 82% in others. Patients who have to wait longer to receive a transplant also have a higher chance of dying after the procedure, as pre-transplant MELD score have been demonstrated to correlate inversely with posttransplant survival. The staggering statistics demonstrate that the costs of waiting for candidates in some areas have indeed been high, lowering their chances of survival both before and after transplant.
Massie AB, Caffo B, Gentry SE, et al. MELD exceptions and rates of waiting list outcomes. Am J Transplant 2011; 11(11): 2362–2371.
Yeh H, Smoot E, Schoenfeld DA, Markmann JF. Geographic inequity in access to livers for transplantation. Transplantation. 2011; 91(4):479–486.
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