Small steps versus big leaps in changing liver distribution policy

✍ Scribed by Richard B. Freeman Jr

• Publisher: John Wiley and Sons
• Year: 2011
• Tongue: English
• Weight: 53 KB
• Volume: 17
• Category: Article
• ISSN: 1527-6465
• DOI: 10.1002/lt.22376

✦ Synopsis

There are numerous examples demonstrating that the availability, quality, and cost of various forms of medical treatment vary greatly across geographic regions in the United States and around the world. To some degree, this variation is manageable by the development of health care delivery and payment policies that are designed to standardize the criteria defining when and where treatment should be offered. However, in the world of transplantation, the extreme scarcity of organs has intensified the debate about the variations in availability. In the United States, liver distribution is spread across very different geographic regions containing heterogeneous groups of populations, transplant centers, and organ procurement organizations. Donor service areas (DSAs), which are assigned by the US Department of Health and Human Services for the purpose of organ procurement, are also currently used by the Organ Procurement and Transplantation Network (OPTN) to define the smallest unit for liver organ distribution. Because the purpose of DSAs is focused on organ procurement service coverage, there is little correlation between DSAs and the dynamics of liver transplant waiting lists, the density of liver transplant centers, or the overall potential donor populations in their areas. For this reason, it is not surprising that there are widespread variations in the availability of donor organs, in the severity of a candidates' disease [as measured by the Model for End-Stage Liver Disease (MELD) score] when an organ is offered, and in the composition of liver candidate waiting lists among DSAs.