Geographical Disparity in Access to Organ Transplant in the United States and Other Western Countries: A Prolegomenon to A Solution

Abstract

Background: Disparities in access to and in outcome of organ transplantation are widely discussed topics among transplant researchers in many Western countries. Among various types of disparities examined in existing studies, “geographic disparity,” i.e., disparity due to a recipient's location, is most common. Despite a number of articles that acknowledge the existence of geographic disparities, the literature has been relatively silent about the historical and international efforts to address these issues. Literature discussing remedies or proposing analytical tools to identify remedies is even rarer. This paper investigates potential causes of geographic disparity and advocates possible methodological approaches to analyze and address the disparity. Methods: The paper conducts an in‐depth review of geographic disparity and the policy efforts to reduce the disparity in the United States, Canada, France, Spain, the United Kingdom, and Australia. The current organ allocation systems in these countries are also reviewed and compared. Possible causes of the disparity and future analytical approaches are discussed based on the findings of these reviews. Findings: Geographic disparity in organ transplant service is ubiquitous in all countries studied. Many Western countries have a similar organ allocation system with some difference in the degree of interregional and national‐level sharing enforced by the government. The organ allocation system in these countries tends to have some inherent mechanism to favor a “home region” where organs are harvested, implying that the locations of candidates matter in accessing a transplant. Geographic allocation boundaries prevalent in the United States were found to be another potential source of geographic disparity. Conclusions: Developing an equitable organ allocation system is a multifaceted problem. The allocation procedure needs to reflect priorities of urgent cases and some geographic areas, patient's severity level, waiting time, cold ischemia time (CIT) and associated travel distance, condition of and compatibility between organ and recipient, etc. Failing to reflect these factors adequately results in disparity of some sort. The implications of geographic boundaries in organ allocation need to be studied further. Utilization of relatively new methodological approaches, such as Geographic Information Systems (GIS) and system dynamic modeling, would help develop a system that allocates organs more equitably.

The relationship between social networks and pathways to kidney transplant parity: Evidence from black Americans in Chicago

“…Interventions such as patient navigation (Freeman, 2006) that help disadvantaged patients navigate the barriers to seeking treatment for chronic illnesses such as cancer is one example of such an intervention, and may be a way to address other health care disparities through informational and instrumental social support. This study also has international implications for further research, as kidney transplant racial disparities exist in Canada (Yeates et al, 2004), Australia (Cass, Cunningham, Snelling, Wang, & Hoy, 2003), France, Spain, and the United Kingdom (Koizumi, 2010). Considering dialysis patients’ social milieu can be complementary to the existing research regarding kidney transplant disparity in the United States and beyond.…”

Consumerist Responses to Scarcity of Organs for Transplant

“…A number of factors contribute to these discrepancies, including regional differences in the supply and demand for donor organs [8], centers' organ acceptance practices [8], the geographical boundaries of UNOS transplant regions and donor service areas (DSA) within them [9,10], and the size and characteristics of the potential donor populations [8].…”

Impact of County Health Rankings on Nationwide Liver Transplant Outcomes

“…Studies from across the world have found that access to transplant centers, the likelihood of being listed, and transplant outcomes are not equitable across all geographic areas. [12][13][14][15][16][17][18][19] However, social determinants of health (SDOH), which also vary by location, have not been widely studied in relation to transplant. SDOH include income, educational level, physical environment, social support, and access to quality healthcare services have each been demonstrated to significantly impact patients' health and response to medical treatment in multiple areas of medicine.…”