Liver redistricting: what are the upcoming changes in liver allocation in the United States?

Geographic disparity in liver transplantation is substantial in the United States, and primarily a byproduct of artificially created zones of organ distribution. In 2016, the United Network for Organ Sharing (UNOS) put forward a formal redistricting proposal with the goal of reducing this variability by regrouping the country's 58 donation service areas into eight new districts. This review provides a summary of the redistricting proposal's methodologies, expected results, criticisms and next steps.

Previous authors have extensively evaluated the limitations of the current organ allocation and distribution system and how inequities in access to liver transplantation occur. However, few have suggested or simulated new ways to solve or improve this process. The 2016 UNOS redistricting proposal constitutes the first formal evaluation of a novel distribution model. This proposal and its shortcomings have led to multiple discussions throughout the transplant community and encouraged further research in this field.

This review provides an updated perspective on the key organ distribution issues facing the US transplant community at large, and how UNOS and other experts suggest the problem of geographic disparity in liver transplantation should be solved.