Access to liver transplantation for minority populations in the United States

Abstract

Purpose of review Racial disparities in access to liver transplantation have been known since the National Transplant Act of 1980. Since the inception of the Final Rule in 2000, the United Network of Organ Sharing has sought to ensure the equitable distribution of donor livers. Despite several measures aimed to improve access for vulnerable populations, disparities in outcomes are still prevalent throughout the liver transplant (LT) evaluation, while on the waitlist, and after liver transplantation. Recent findings Blacks and Hispanics are underrepresented on the LT list and have an increased waitlist mortality rate compared to Whites. Additionally, Blacks have a significantly higher risk of posttransplant mortality. Summary Ongoing efforts are necessary to eliminate inequities in transplant access. Strategies such as policy implementation and increasing diversity in the healthcare workforce may prove efficacious in creating change.

Geospatial Analysis of Organ Transplant Referral Regions

“… 1 Women, racial and ethnic minority populations, and patients with public insurance, low educational level, and low income all have lower rates of listing for organ transplant, higher rates of waitlist mortality, and lower rates of transplant from living donors. 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 Transplantation is a highly complex, often regionalized system of care that requires completion of a multi-step conditional selection process. Inequities in access to transplantation likely result from a combination of the complexity of the transplant selection process and individual social conditions (eg, health literacy, employment, access to transportation) that burden patients as they navigate the process.…”

“…Inequities in access to organ transplant are longstanding, having been described for over 20 years . Women, racial and ethnic minority populations, and patients with public insurance, low educational level, and low income all have lower rates of listing for organ transplant, higher rates of waitlist mortality, and lower rates of transplant from living donors . Transplantation is a highly complex, often regionalized system of care that requires completion of a multi-step conditional selection process.…”

Impact of acuity circles on racial and ethnic disparities in liver transplantation

“…[1] Existing disparities within the previous policy are well documented, such as the underrepresentation of non-Hispanic Black and Hispanic patients on the liver transplant (LT) waitlist and higher mortality for minority populations on the waitlist. [2] Concerns were raised that the AC policy would differentially harm racial and ethnic minorities by shifting transplants from areas of higher-minority populations to lower-minority populations, thereby exacerbating existing disparities in access to LT. Since the implementation of the AC policy, studies have demonstrated several positive (eg, increased transplantation of high MELD patients) and negative (eg, increased travel and costs) consequences.…”

The Transplant Trolley Problem

“…We are willing to take their organs, but not willing to transplant-surely a social justice issue. 13 Another long-standing issue has to do with the buying of organs, having individuals travel to countries where they are engaged in purchasing organs despite the long-term deleterious effects to the donor's health. However, there are economic benefits that should be taken into consideration: first to the institution and second to the individual donor.…”