State-Based Liver Distribution: Broad Sharing With Less Harm to Vulnerable and Underserved Communities Compared With...

Area of Science:

• Transplantation research
• Organ allocation policy
• Public health equity

Background:

• Regulatory pressure is increasing for broader sharing of livers for transplantation.
• Current proposals, like concentric circles, have poorly understood effects on socioeconomic inequities in transplant access.

Purpose of the Study:

• To propose and evaluate a state-based liver distribution model.
• To assess the impact of state-based distribution on system efficiency, organ discards, and patient access, particularly for vulnerable populations.

Main Methods:

• Utilized the Scientific Registry of Transplant Recipients liver simulated allocation model algorithm.
• Generated comparative estimates of regional transplant volume and wait-list access disparities.
• Analyzed the impact on vulnerable and high-risk patients.

Main Results:

• State-based liver distribution demonstrated superior system efficiency, reduced organ discards, and minimized organ transport flights.
• The efflux of organs from vulnerable areas with less wait-list access was more than halved compared to concentric circle models.
• The proposed state-based system showed improved equity in access to transplant services.

Conclusions:

• A state-based organ distribution system is a legally defensible, practical, and ethically sound alternative to geometric distribution models.
• This model addresses socioeconomic inequities and enhances overall efficiency in liver transplantation.
• State-based allocation offers a more equitable approach to organ sharing.