Purpose: To characterize the balance of supply and demand for deceased donor livers in the current Organ Procurement and Transplantation Network (OPTN) regions and in conceptualized new districts.

Methods: Three measures of deceased donor liver supply were collected from 2013 (latest available) data: actual liver donors and eligible donors from OPTN, and total deaths from the US Census Bureau. These were divided by counts of OPTN liver waitlist patients with MELD/PELD (M/P) > 15 to create supply-demand ratios, which were evaluated in the current 11 OPTN regions and in previously-described 8- and 4-district allocation systems designed to reduce disparity in MELD at transplant (Gentry, Am J Transplant 2013).

Results: Supply-demand ratios varied widely across the 52 donation service areas (DSAs) with active liver programs in 2013 (Figure 1). The existing 11 regions had a 2.5-fold difference in the ratio of eligible deaths to waitlist candidates with M/P > 15 (Table 1, 0.24-0.62), with the conceptual 8- and 4-district maps reducing the range substantially (0.37-0.51; 0.37-0.43). Similar results were obtained for other supply metrics.

Conclusions: Supply and demand for deceased donor livers vary widely and independently of each other across the country. Optimized district boundaries could markedly improve geographic disparity in supply to demand ratios compared with the current 11 regions.

CITATION INFORMATION: Pyke J, Schladt D, Zeglin J, Xiong H, Gentry S, Kim W, Lake J, Israni A. Geographic Variation in Liver Supply and Demand. Am J Transplant. 2016;16 (suppl 3).

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