Neehar D Parikh1, Wesley J Marrero, Christopher J Sonnenday, Anna S Lok, David W Hutton, Mariel S Lavieri. 1. 1 Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI.2 Industrial and Operational Engineering, University of Michigan, Ann Arbor, MI.3 Department of Surgery, University of Michigan, Ann Arbor, MI.4 School of Public Health, University of Michigan Ann Arbor, MI.
Abstract
BACKGROUND: To reduce the geographic heterogeneity in liver transplant allocation, the United Network of Organ Sharing has proposed redistricting, which is impacted by both donor supply and liver transplantation demand. We aimed to determine the impact of demographic changes on the redistricting proposal and characterize causes behind geographic heterogeneity in donor supply. METHODS: We analyzed adult donors from 2002 to 2014 from the United Network of Organ Sharing database and calculated regional liver donation and utilization stratified by age, race, and body mass index. We used US population data to make regional projections of available donors from 2016 to 2025, incorporating the proposed 8-region redistricting plan. We used donors/100 000 population age 18 to 84 years (D/100K) as a measure of equity. We calculated a coefficient of variation (standard deviation/mean) for each regional model. We performed an exploratory analysis where we used national rates of donation, utilization and both for each regional model. RESULTS: The overall projected D/100K will decrease from 2.53 to 2.49 from 2016 to 2025. The coefficient of variation in 2016 is expected to be 20.3% in the 11-region model and 13.2% in the 8-region model. We found that standardizing regional donation and utilization rates would reduce geographic heterogeneity to 4.9% in the 8-region model and 4.6% in the 11-region model. CONCLUSIONS: The 8-region allocation model will reduce geographic variation in donor supply to a significant extent; however, we project that geographic disparity will marginally increase over time. Though challenging, interventions to better standardize donation and utilization rates would be impactful in reducing geographic heterogeneity in organ supply.
BACKGROUND: To reduce the geographic heterogeneity in liver transplant allocation, the United Network of Organ Sharing has proposed redistricting, which is impacted by both donor supply and liver transplantation demand. We aimed to determine the impact of demographic changes on the redistricting proposal and characterize causes behind geographic heterogeneity in donor supply. METHODS: We analyzed adult donors from 2002 to 2014 from the United Network of Organ Sharing database and calculated regional liver donation and utilization stratified by age, race, and body mass index. We used US population data to make regional projections of available donors from 2016 to 2025, incorporating the proposed 8-region redistricting plan. We used donors/100 000 population age 18 to 84 years (D/100K) as a measure of equity. We calculated a coefficient of variation (standard deviation/mean) for each regional model. We performed an exploratory analysis where we used national rates of donation, utilization and both for each regional model. RESULTS: The overall projected D/100K will decrease from 2.53 to 2.49 from 2016 to 2025. The coefficient of variation in 2016 is expected to be 20.3% in the 11-region model and 13.2% in the 8-region model. We found that standardizing regional donation and utilization rates would reduce geographic heterogeneity to 4.9% in the 8-region model and 4.6% in the 11-region model. CONCLUSIONS: The 8-region allocation model will reduce geographic variation in donor supply to a significant extent; however, we project that geographic disparity will marginally increase over time. Though challenging, interventions to better standardize donation and utilization rates would be impactful in reducing geographic heterogeneity in organ supply.
Authors: Mary G Bowring; Sheng Zhou; Eric K H Chow; Allan B Massie; Dorry L Segev; Sommer E Gentry Journal: Transplantation Date: 2019-10 Impact factor: 4.939
Authors: Christine E Haugen; Tanveen Ishaque; Abel Sapirstein; Alexander Cauneac; Dorry L Segev; Sommer Gentry Journal: Am J Transplant Date: 2019-03-18 Impact factor: 8.086
Authors: Jayme E Locke; Brittany A Shelton; Kim M Olthoff; Elizabeth A Pomfret; Kimberly A Forde; Deirdre Sawinski; Meagan Gray; Nancy L Ascher Journal: JAMA Surg Date: 2020-07-15 Impact factor: 14.766