Gerrymandering for liver transplants?

For anyone involved with liver transplantation, it will come as no surprise that living in certain areas of the country puts you at a disadvantage on the liver transplant list.  The New England region as well as California have notoriously long waits for new livers.  Why?  Part of the issue is variations in organ donor rates between different parts of the country.  In some regions, rates of liver disease are higher meaning the demand for organs is higher.  And some regions of the country are relatively safe compared to others – meaning there are less young and healthy individuals who unfortunately suffer trauma and later become organ donors.

Much like political parties get to rearrange the political map during years of a census, Dr Dorry Segev wants to “redistrict” how livers are allocated.  He is advising the United Network for Organ Sharing (UNOS), which runs the transplant network, to redraw the nation’s 11 transplant regions based on the distribution and demand for donated organs.

Because ultimately, your chance of dying while waiting for a liver transplant shouldn’t depend on your ZIP code.  According to the National Center of Health Statistics, 6,256 patients received a liver transplant last year.  Nearly 16,000 people are currently waiting for a liver, and about 1,500 people die waiting every year.

Given the disparity in wait times, UNOS does allow patients to travel outside of their home region and be listed in other regions.  But there are several hurdles to this approach – the first is that many don’t even know it’s a possibility.  The largest obstacle is expense – Medicare and most insurance companies won’t pay for a liver transplant that occurs outside of your home region, making it difficult to the less wealthy.  Finally, one needs to travel to that other region on a moment’s notice if a liver becomes available, and livers only last so long on ice.  The best-known example is the late Apple CEO Steve Jobs.  Jobs had his liver transplant in Tennessee in 2009 though he lived in California (Tennessee has much shorter wait times), but a private jet makes traveling across the country on a dime while a liver is still viable a lot easier to do.


About justgngr

the ramblings of a medical professional by day, judgmental ginger by night
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