Many of the 17,000 people currently waiting for liver transplants in the U.S. have had bags packed for weeks, months, or even years, ready for the moment the phone rings and the voice on the other end tells them to head to the hospital. Once an organ becomes available, they know, there will only be a small window in which they can receive it. This year, an estimated 6,000 of those people will undergo a transplant; another 1,500 will die waiting for that call. There just aren’t enough livers to go around.
The task of determining who on the waiting list should receive a new organ falls to the United Network for Organ Sharing (UNOS), a non-profit organization that coordinates transplants across the U.S. When a liver becomes available, someone from the organization enters the donor’s information—weight, blood type, geographical location—into a computer system, which spits out a list of patients who would be a good match. The program then ranks the patients based on an objective measure of illness, called a Model End-Stage Liver Disease (MELD) score. The patient most likely to die gets put at the top of the list, with first dibs on the organ. “It’s balancing equity in regards to patient access,” explained David Klassen, the chief medical officer of UNOS, “[while] making sure that the outcomes from the transplant surgeries are as good as possible.”
But access to organs is far from equitable. One of the biggest challenges UNOS faces is geographic disparity in access to organs—some parts of the country have far more organ donors than others, and organs can only be preserved and shipped for a limited time before transplantation. The country is divided into 11 Organ Procurement and Transplantation Network (OPTN) regions; across those 11 regions, typical wait times for organs across the country range from one year to more than six.
Researchers have been studying ways to tackle this issue for years, but the disparity also has another, more fine-grained element. A study recently published in the Journal of Hepatology identified a substantial, yet often overlooked, barrier to access: the likelihood that a particular transplant center will choose to use the organs when they are available.
Improving organ utilization practices is the focus for The Alliance’s National Critical Issues Forum this year (2016). To read more details and learn how to register for this meeting, click here.