Proposals by the United Network for Organ Sharing (UNOS) to more broadly share livers on the basis of apparent need may instead increase deaths among already underserved populations. That’s what a new study conducted by Raymond Lynch, MD, recently a hepatologist at The University of Kansas Health System and now from Emory University in Atlanta and David Goldberg, MD, from the University of Pennsylvania in Philadelphia clearly shows. The doctors presented their findings at The American Transplant Congress in Chicago earlier this week The study shows that livers from socially disadvantaged areas would be diverted from local recipients and sent to areas of greater privilege. “Multiple studies have documented the lower rate at which minorities are waitlisted and transplanted,” says Lynch. “Patients of lower socioeconomic status already have a higher waitlist death rate as well as reduced access to high-volume, high-quality transplant centers.”
This study evaluated 114,347 liver transplant candidates between 2002 and 2014 and found that a travel distance of greater than 25 miles was associated with increased mortality. Using Community Health Scores to track socioeconomic disadvantage, they found poverty, minority race and rural residence independently predicted reduced access and increased mortality. Models created by UNOS would pull livers away from patients living in these areas.
“Simply put, our study shows the more underserved your community and/or the farther you live from a transplant center, the greater your chances of dying while waiting for a transplant,” says Lynch. “People living in these areas are recognized by Congress as deserving special study and protection. Unfortunately, in attempting to fix one aspect of transplantation, the proposed redistricting plan would predominantly reduce access and increase risk for the most vulnerable patients. We need to use this as an opportunity to redesign distribution in a way that recognizes individual risk and fulfills our obligation to underserved communities.”
For more information on this issue, visit “Keep Transplants Fair” at http://keeptransplantsfair.org/