The authors, from well-respected and accomplished liver transplant centers in Houston and San Antonio, write of the geographic disparities and deceased donor liver transplantation within United Network for Organ Sharing region 4. 1 They note significant differences in Model for End-Stage Liver Disease scores at liver transplant for non-status 1 candidates, importantly point to data showing greater risk of being delisted, and point out that the risk of being delisted is directly proportional to the donor service area (DSA) size and varies among the four DSAs.
Regrettably, this analysis is incomplete and perhaps disingenuous. First, the time period covered in this data analysis precedes the implementation of the mandatory share 15 rule, which may well have a significant impact both in region 4 and nationally on transplant rates and may obviate the differences within DSAs.
Second, the authors advocate for increased intraregional sharing of liver allografts, yet they are the same group who brought this issue before the liver intestine committee at the United Network for Organ Sharing, which prompted Scientific Registry of Transplant Recipients modeling of broader geographic sharing within region 4.