Journal
AMERICAN JOURNAL OF TRANSPLANTATION
Volume 13, Issue 8, Pages 2052-2058Publisher
WILEY
DOI: 10.1111/ajt.12301
Keywords
Broader sharing; geographic disparities; liver allocation; Liver Simulated Allocation Model
Categories
Funding
- HHS/HRSA
- American Recovery and Reinvestment Act grant from the National Institute of Diabetes Digestive and Kidney Diseases [RC1 1RC1DK086450-01]
- US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation [HHSH250201000018C]
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Severe geographic disparities exist in liver transplantation; for patients with comparable disease severity, 90day transplant rates range from 18% to 86% and death rates range from 14% to 82% across donation service areas (DSAs). Broader sharing has been proposed to resolve geographic inequity; however, we hypothesized that the efficacy of broader sharing depends on the geographic partitions used. To determine the potential impact of redistricting on geographic disparity in disease severity at transplantation, we combined existing DSAs into novel regions using mathematical redistricting optimization. Optimizedmaps and current maps were evaluated using the Liver Simulated Allocation Model. Primary analysis was based on 6700 deceased donors, 28 063 liver transplant candidates, and 242 727 Model of End-Stage Liver Disease (MELD) changes in 2010. Fully regional sharing within the current regional map would paradoxically worsen geographic disparity (variance in MELD at transplantation increases from 11.2 to 13.5, p = 0.021), although it would decrease waitlist deaths (from 1368 to 1329, p = 0.002). In contrast, regional sharing within an optimized map would significantly reduce geographic disparity (to 7.0, p = 0.002) while achieving a larger decrease in waitlist deaths (to 1307, p = 0.002). Redistricting optimization, but not broader sharing alone, would reduce geographic disparity in allocation of livers for transplant across the United States.
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