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Access to Liver Transplantation: Gender, Race and Geographic Disparities


Liver transplantation is the treatment of choice for End Stage Liver Failure patients. The limiting factor in providing liver transplantation is organ availability. Despite the implementation of an acuity based cadaveric liver allocation system in 2002, limited research addresses disparity in access to this scarce resource in this current era of allocation.

The primary purpose of this research project was to increase the understanding and the effect of specific predisposing, enabling and need variables in access to liver transplantation by comparing cadaveric transplant recipients to those who continued to wait for a cadaveric liver from February 27, 2002 through November 30, 2007. The study analyzed secondary data from the federally mandated database managed by the Organ Procurement Transplant Network and the United Network of Organ Sharing that included 32,566 patients. The acuity-based model of organ allocation (MELD) adopted in 2002 was used to control for acuity at the time of transplant. Using two sets of Cox Proportional Hazard Regression analyses, time to transplant and potential disparities were evaluated. Because the analysis showed that the likelihood of receiving a cadaveric liver transplant doubled for those with MELD scores greater than or equal to 15 after the implementation of a minimum MELD score rule in 2005, the model used a dummy variable to control for the time period (after the 2005 rule adoption). The regression models found disparities in time to transplant by gender, race, and age, and geographic location controlling for acuity, time period, predisposing, enabling and need variables. Women were found to be 13 percent less likely to receive liver transplants then men. African Americans, Hispanics and Asians were found to be 11, 19 and 16 percent less likely than whites to receive a liver transplant respectively. In addition significant regional differences in hazard of transplant were discovered. There was wide variation in access time across regions with an increased likelihood of transplantation from 11 to102 percent in selected regions. Disparities in gender, race, and payer status were found across UNOS regions as well. These disparities across gender, race and geographical region suggest the need for an evaluation of the federally mandated system of allocation.

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