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. 2014 Oct;20(10):1237-43.
doi: 10.1002/lt.23942.

Impact of broader sharing on the transport time for deceased donor livers

Sommer E Gentry  1 , Eric K H Chow, Corey E Wickliffe, Allan B Massie, Tabitha Leighton, Dorry L Segev
Affiliations

Impact of broader sharing on the transport time for deceased donor livers

Sommer E Gentry et al. Liver Transpl. 2014 Oct.

Abstract

Recent allocation policy changes have increased the sharing of deceased donor livers across local boundaries, and sharing even broader than this has been proposed as a remedy for persistent geographic disparities in liver transplantation. It is possible that broader sharing may increase cold ischemia times (CITs) and thus harm recipients. We constructed a detailed model of transport modes (car, helicopter, and fixed-wing aircraft) and transport times between all hospitals, and we investigated the relationship between the transport time and the CIT for deceased donor liver transplants. The median estimated transport time was 2.0 hours for regionally shared livers and 1.0 hour for locally allocated livers. The model-predicted transport mode was flying for 90% of regionally shared livers but for only 22% of locally allocated livers. The median CIT was 7.0 hours for regionally shared livers and 6.0 hours for locally allocated livers. Variation in the transport time accounted for only 14.7% of the variation in the CIT, and the transport time on average composed only 21% of the CIT. In conclusion, nontransport factors play a substantially larger role in the CIT than the transport time. Broader sharing will have only a marginal impact on the CIT but will significantly increase the fraction of transplants that are transported by flying rather than driving.

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Figures

Figure 1
Figure 1. transport mode selection
The time required for transportation by car, helicopter, and airplane were estimated for adult liver transplants in 2010. Transports were assigned one of the three transport modes according to the flowchart shown. The number of livers estimated to have been transported by each mode is shown, along with the median (IQR) transport distance (n=4907 transports).
Figure 2
Figure 2. example of driving, helicopter, and fixed-wing aircraft routes between a donor hospital and a transplant center
Transports by car were estimated to follow directions as provided by Google Maps. Transports by helicopter were estimated to depart and arrive from the hospital helipad (or nearest helipad within 15 minutes). Transports by flight were estimated to be flown between the nearest airports, with driving directions between the hospital and airport provided by Google Maps.
Figure 3
Figure 3. distribution of estimated transport time
Histogram of all 2010 adult liver transplants (n=4907).
Figure 4
Figure 4. Distribution of cold ischemia times, by categories of estimated transport time
n=4907 adult liver transplants from 2010.
Figure 5
Figure 5. Relationship of estimated transport time to transport distance
Estimated transport mode denoted by marker shape. Transports with distances less than 200 miles are shown (n=3781) of a total of n=4907 transports. Median (IQR) distance was 65 (8.4 – 190) miles. Median (IQR) estimated transport time was 1.4 (0.33 – 1.9) hours.
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References

    1. Washburn K, Harper A, Klintmalm G, Goss J, Halff G. Regional sharing for adult status 1 candidates: reduction in waitlist mortality. Liver Transpl. 2006;12(3):470–474. - PubMed
    1. OPTN. Policy 9: Allocation of Livers and Liver-Intestines In. 2014:121–132.
    1. Washburn K, Pomfret E, Roberts J. Liver allocation and distribution: possible next steps. Liver Transpl. 2011;17(9):1005–1012. - PubMed
    1. Roberts JP, Dykstra DM, Goodrich NP, Rush SH, Merion RM, Port FK. Geographic differences in event rates by model for end-stage liver disease score. Am J Transplant. 2006;6(10):2470–2475. - PubMed
    1. Massie AB, Caffo B, Gentry SE, Hall EC, Axelrod DA, Lentine KL, et al. MELD Exceptions and Rates of Waiting List Outcomes. Am J Transplant. 2011;11(11):2362–2371. - PMC - PubMed

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