Geographic disparity in access to deceased-donor liver transplantation is well described. The available liver supply in a DSA may affect patient and provider decisions on organ offers

METHODS: Using SRTR offer data 2010-2014, we identified 12,529 deceased-donor livers and estimated the association between DSA-level offer acceptance and DSA supply-demand ratio using modified Poisson regression adjusting for donor factors. Supply-demand ratio (recovered livers to incident waitlist candidates) was stratified into quartiles, highest quartile indicating greatest supply of livers per candidate. The models were further stratified into national, regional, and local offers.

RESULTS: DSAs within the lowest supply quartile accepted 88.3% of local offers, while DSAs within each increasing quartile accepted 86.9%, 84.5%, and 75.5% of local offers, respectively. This trend persisted among regional and national offers (Figure). The association between supply and acceptance varied by offer type (p-value interaction<0.001). Compared to DSAs with the lowest liver supply, DSAs with the highest liver supply were 15% (aRR: _0.820.85_0.88), 39% (aRR: _0.540.61_0.69), and 75% (aRR: _0.130.25_0.47) less likely to accept local, regional, and national offers, respectively (Table). DSAs within the two uppermost quartiles of supply had similarly low acceptance of regional and national offers, however, they differed in acceptance of local offers.

CONCLUSIONS: Higher availability of livers per candidate within a DSA was strongly associated with lower liver offer acceptance within that DSA. Allocation schemes that provide greater equity in deceased-donor availability might minimize geographic disparity and also reduce liver discard driven by high refusal rates.

CITATION INFORMATION: Bowring M., Zhou S., Massie A., Gentry S., Segev D. Impact of Local Liver Supply on Liver Offer Acceptance Am J Transplant. 2017;17 (suppl 3).

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