Today, many of the patients on the nation’s organ transplant list continue to wait longer than they should for an organ. Economic and geographic disparities continue to plague the organ transplant system. Where you live and how much money you make should not determine whether you live or die while waiting for an organ, but sadly, this is a reality that many Americans face each year.
What role does the government play?
Currently, 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.
In 1994, Congress reauthorized the National Organ Transplant Act (NOTA), clarifying that its intent “was to ensure patients that no matter who they were, or where they live, they would have a fair chance of receiving a necessary organ transplant.” In 1998, HRSA promulgated a Final Rule implementing NOTA, which highlighted existing geographic disparities and required implementation of policies “that provide organs to those with the greatest medical urgency… wherever they live.”
What are OPTN and UNOS doing now?
At its meeting last month Chicago, OPTN formally reviewed analysis of proposals to adopt larger districts for broader organ sharing as well as newer “neighborhood” and “concentric circle” approaches that would achieve the same goal. OPTN also accepted extensive public comment on these issues at the meeting
At least one of the proposals will likely be posted online for written comments in late summer. OPTN will solicit this feedback, and move forward with a vote to determine whether the new model will be implemented.
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