Raymond J Lynch1,2, Rachel E Patzer1,2,3. 1. Division of Transplantation, Department of Surgery. 2. Health Services Research Center, Emory University School of Medicine. 3. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
Abstract
PURPOSE OF REVIEW: Scarcity is a defining feature of the modern transplant landscape, and in light of chronic shortages in donor organs, there is cause for concern about geographic inequities in patients' access to lifesaving resources. Recent policy changes designed to ameliorate unequal donor supply and demand have brought new interest to measuring and addressing disparities at all stages of transplant care. The purpose of this review is to describe an overview of recent literature on geographic inequities in transplant access, focusing on kidney, liver, and lung transplantation and the impact of policy changes on organ allocation. RECENT FINDINGS: Despite a major change to the kidney allocation policy in 2014, geographic inequity in kidney transplant access remains. In liver transplantation, the debate has centered on the median acuity score at transplantation; however, a more thorough examination of disparities in access and survival has emerged. SUMMARY: Geographic differences in access and quality of transplant care are undeniable, but existing disparity metrics reflect disparities only among candidates who are waitlisted. Future research should address major gaps in our understanding of geographic inequity in transplant access, including patients who may be transplant-eligible but experience a wide variety of barriers in accessing the transplant waiting list.
PURPOSE OF REVIEW: Scarcity is a defining feature of the modern transplant landscape, and in light of chronic shortages in donor organs, there is cause for concern about geographic inequities in patients' access to lifesaving resources. Recent policy changes designed to ameliorate unequal donor supply and demand have brought new interest to measuring and addressing disparities at all stages of transplant care. The purpose of this review is to describe an overview of recent literature on geographic inequities in transplant access, focusing on kidney, liver, and lung transplantation and the impact of policy changes on organ allocation. RECENT FINDINGS: Despite a major change to the kidney allocation policy in 2014, geographic inequity in kidney transplant access remains. In liver transplantation, the debate has centered on the median acuity score at transplantation; however, a more thorough examination of disparities in access and survival has emerged. SUMMARY: Geographic differences in access and quality of transplant care are undeniable, but existing disparity metrics reflect disparities only among candidates who are waitlisted. Future research should address major gaps in our understanding of geographic inequity in transplant access, including patients who may be transplant-eligible but experience a wide variety of barriers in accessing the transplant waiting list.
Authors: Robert M Cannon; Ariann Nassel; Jeffery T Walker; Saulat S Sheikh; Babak J Orandi; Malay B Shah; Raymond J Lynch; David S Goldberg; Jayme E Locke Journal: Transplantation Date: 2022-05-09 Impact factor: 5.385
Authors: Sudeshna Paul; Taylor Melanson; Sumit Mohan; Katherine Ross-Driscoll; Laura McPherson; Raymond Lynch; Denise Lo; Stephen O Pastan; Rachel E Patzer Journal: Am J Transplant Date: 2020-09-15 Impact factor: 8.086