Introduction: In the United States, the system to allocate solid organs for transplantation is regulated and maintained by the United Network for Organ Sharing (UNOS). The UNOS/OPTN recently approved a major change of the system used to allocate hearts for adult transplant candidates nationwide. The newly approved heart policy alters the categorization of patients into severity status and the sequence of allocation for the most urgent candidate. While the new policy is expected to improve transplant rates and waiting time for the most severe patients, the transplant community has voiced a number of concerns regarding geographic disparity in access to heart transplant in the current system. The main goal of this study is to measure geographic disparities in access to heart transplant across OPOs and regions in the US.

Methods: We use a simulation model to measure geographic disparities in access to heart transplant. Several metrics are considered including transplant rate, waiting time and pre-transplant mortality rate. We define a new measure of access which accounts simultaneously for the distance between donor hospitals and transplant centers, and the supply/demand ratio at each transplant center.

Results: At the OPO level the minimum, maximum and median transplant rate are, respectively: 0.21, 0.73 and 0.47. At the regional level the minimum, maximum and median transplant rate are, respectively: 0.38, 0.77 and 0.46. Waiting time across OPO varies from a minimum of 17.62 days to a maximum of 605.9 days with a standard deviation equal to 78.39 days; across regions, it varies from 112 to 187 days (st. dev. = 23.1). Pre-transplant mortality rate ranges between 0.4 and 0.56 at the OPO level, and between 0.21 and 0.32 at the regional level. Our access measure reveals a 55% gap between the minimum and the maximum value at the OPO level and 77% at the region level.

Conclusion: The results show the need for a change in the heart allocation system to overcome geographic disparity.

CITATION INFORMATION: Karami F., Nayebpour M., Gentili M., Koizumi N., Rivard A. Analyzing Geographic Disparity in the US Heart Allocation System Am J Transplant. 2017;17 (suppl 3).

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