As the OPTN/UNOS Liver and Intestinal Organ Transplantation Committee considers a proposal to reform the current system for liver distribution, some opponents of the proposal have said that existing disparities in organ distribution are linked to the performance of OPOs in that region. OPO performance has been measured based on two factors: liver yield and liver donor conversion ratio. While some stakeholders have suggested OPO performance underlies the existing disparity, empirical evidence demonstrates that the current inequity is due to large differences in demand across regions. Furthermore, even if every OPOs performed optimally, the current disparity would continue.
Instead, lower performance ratings among OPOs in disadvantaged regions are driven by many of the same factors which lead to disparities in liver distribution. The Committee’s proposal explicitly states “[r]ecent studies have demonstrated that, after adjusting for differences in population, there is an estimated 14-fold difference among the DSAs in the rates of liver candidates added to the waiting list and a 3-fold difference in eligible deaths; however, there is only a two-fold difference in OPO performance.” Opponents of liver distribution reform, however, who attack OPO performance as the source of inequity, have routinely relied on such ‘red herring’ logic to distract from the fact that reform proposals would be a marked improvement to the current system – and ultimately, save lives.