Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Oct 1;26(5):547-553.
doi: 10.1097/MOT.0000000000000914.

Geographic disparities in transplantation

Paolo R Salvalaggio  1
Affiliations
Review

Geographic disparities in transplantation

Paolo R Salvalaggio. Curr Opin Organ Transplant. .

Abstract

Purpose of review: The Final Rule clearly states that geography should not be a determinant of a chance of a potential candidate being transplanted. There have been multiple concerns about geographic disparities in patients in need of solid organ transplantation. Allocation policy adjustments have been designed to address these concerns, but there is little evidence that the disparities have been solved. The purpose of this review is to describe the main drivers of geographic disparities in solid organ transplantation and how allocation policy changes and other potential actions could impact these inequalities.

Recent findings: Geographical disparities have been reported in kidney, pancreas, liver, and lung transplantation. Organ Procurement and Transplant Network has modified organ allocation rules to underplay geography as a key determinant of a candidates' chance of receiving an organ. Thus, heart, lung, and more recently liver and Kidney Allocation Systems have incorporated broader organ sharing to reduce geographical disparities. Whether these policy adjustments will indeed eliminate geographical disparities are still unclear.

Summary: Modern allocation policy focus in patients need, regardless of geography. Innovative actions to further reduce geographical disparities are needed.

PubMed Disclaimer

References

    1. Institute of Medicine. The ‘Final Rule.’ Institute of Medicine: Organ Procurement and Transplantation: Assessing Current Policies and the Potential Impact of the DHHS Final Rule. 1999; Washington, DC: The National Academies Press, 199–213.
    1. Reed RD, Shelton BA, Mustian MN, et al. Geographic differences in population health and expected organ supply in the gulf coast region of the United States compared to Non-Gulf States. Transplantation 2020; 104:421–427.
    1. Pladys CM, Couchoud C, Jacqueline C, et al. Outcome-dependent geographic and individual variations in the access to renal transplantation in incident dialysed patients: a French nationwide cohort study. Transplant Int 2019; 32:369–386.
    1. Wahid NA, Rosenblatt R, Brown RS Jr. A review of the current state of liver transplantation disparities. Liver Transplant 2021; 27:434–443.
    1. Ashby VB, Kalbfleisch JD, Wolfe RA, et al. Geographic variability in access to primary kidney transplantation in the United States, 1996–2005. Am J Transplant 2007; 7 (5 Pt 2):1412–1423.

Publication types