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Ahmed O, Doyle MBM, Abouljoud MS, Alonso D, Batra R, Brayman KL, Brockmeier D, Cannon RM, Chavin K, Delman AM, DuBay DA, Finn J, Fridell JA, Friedman BS, Fritze DM, Ginos D, Goldberg DS, Halff GA, Karp SJ, Kohli VK, Kumer SC, Langnas A, Locke JE, Maluf D, Meier RPH, Mejia A, Merani S, Mulligan DC, Nibuhanupudy B, Patel MS, Pelletier SJ, Shah SA, Vagefi PA, Vianna R, Zibari GB, Shafer TJ, Orloff SL. Liver Transplant Costs and Activity After United Network for Organ Sharing Allocation Policy Changes. JAMA Surg 2024:2819230. [PMID: 38809546 PMCID: PMC11137658 DOI: 10.1001/jamasurg.2024.1208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 02/11/2024] [Indexed: 05/30/2024]
Abstract
Importance A new liver allocation policy was implemented by United Network for Organ Sharing (UNOS) in February 2020 with the stated intent of improving access to liver transplant (LT). There are growing concerns nationally regarding the implications this new system may have on LT costs, as well as access to a chance for LT, which have not been captured at a multicenter level. Objective To characterize LT volume and cost changes across the US and within specific center groups and demographics after the policy implementation. Design, Setting, and Participants This cross-sectional study collected and reviewed LT volume from multiple centers across the US and cost data with attention to 8 specific center demographics. Two separate 12-month eras were compared, before and after the new UNOS allocation policy: March 4, 2019, to March 4, 2020, and March 5, 2020, to March 5, 2021. Data analysis was performed from May to December 2022. Main Outcomes and Measures Center volume, changes in cost. Results A total of 22 of 68 centers responded comparing 1948 LTs before the policy change and 1837 LTs postpolicy, resulting in a 6% volume decrease. Transplants using local donations after brain death decreased 54% (P < .001) while imported donations after brain death increased 133% (P = .003). Imported fly-outs and dry runs increased 163% (median, 19; range, 1-75, vs 50, range, 2-91; P = .009) and 33% (median, 3; range, 0-16, vs 7, range, 0-24; P = .02). Overall hospital costs increased 10.9% to a total of $46 360 176 (P = .94) for participating centers. There was a 77% fly-out cost increase postpolicy ($10 600 234; P = .03). On subanalysis, centers with decreased LT volume postpolicy observed higher overall hospital costs ($41 720 365; P = .048), and specifically, a 122% cost increase for liver imports ($6 508 480; P = .002). Transplant centers from low-income states showed a significant increase in hospital (12%) and import (94%) costs. Centers serving populations with larger proportions of racial and ethnic minority candidates and specifically Black candidates significantly increased costs by more than 90% for imported livers, fly-outs, and dry runs despite lower LT volume. Similarly, costs increased significantly (>100%) for fly-outs and dry runs in centers from worse-performing health systems. Conclusions and Relevance Based on this large multicenter effort and contrary to current assumptions, the new liver distribution system appears to place a disproportionate burden on populations of the current LT community who already experience disparities in health care. The continuous allocation policies being promoted by UNOS could make the situation even worse.
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Affiliation(s)
- Ola Ahmed
- Division of Abdominal Organ Transplantation, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Maria Bernadette Majella Doyle
- Division of Abdominal Organ Transplantation, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Marwan S. Abouljoud
- Transplant Institute and Hepatobiliary Surgery, Henry Ford Hospital Detroit, Detroit, Michigan
| | - Diane Alonso
- Intermountain Medical Center, Salt Lake City, Utah
| | - Ramesh Batra
- Yale New Haven Health Transplantation Center, New Haven, Connecticut
| | - Kenneth L. Brayman
- Division of Transplant Surgery, University of Virginia Health System, Charlottesville
| | | | - Robert M. Cannon
- Comprehensive Transplant Institute, University of Alabama, Tuscaloosa
| | - Kenneth Chavin
- Temple University Health System, Philadelphia, Pennsylvania
| | - Aaron M. Delman
- Department of Surgery, University Cincinnati Medical Center, Cincinnati, Ohio
| | - Derek A. DuBay
- Department of Transplant Surgery, Medical University of South Carolina, Charleston
| | - Jan Finn
- Midwest Transplant Network, Westwood, Kansas
| | - Jonathan A. Fridell
- Department of Abdominal Transplant Surgery, Indiana University Health Transplant Institute, Indianapolis
| | | | - Danielle M. Fritze
- Department of Transplant Surgery, University of Texas Health Science Center at San Antonio
| | - Derek Ginos
- Intermountain Medical Center, Salt Lake City, Utah
| | - David S. Goldberg
- Division of Digestive Health and Liver Diseases, University of Miami Miller School of Medicine, Miami, Florida
| | - Glenn A. Halff
- University of Texas Health Science Center at San Antonio
| | - Seth J. Karp
- Section of Surgical Sciences, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Vivek K. Kohli
- Department of Transplant and Hepatobiliary Surgery, Integris Baptist Medical Center, Oklahoma City, Oklahoma
| | - Sean C. Kumer
- Division of Transplantation and Hepatobiliary Surgery, University of Kansas Health System, Kansas City
| | - Alan Langnas
- Division of Transplant Surgery, University of Nebraska Medical Center, Lincoln
| | - Jayme E. Locke
- Comprehensive Transplant Institute, University of Alabama, Tuscaloosa
| | - Daniel Maluf
- Division of Transplantation and Hepatobiliary Surgery, University of Maryland, Baltimore
| | - Raphael P. H. Meier
- Division of Transplantation and Hepatobiliary Surgery, University of Maryland, Baltimore
| | | | - Shaheed Merani
- Division of Transplant Surgery, University of Nebraska Medical Center, Lincoln
| | - David C. Mulligan
- Yale New Haven Health Transplantation Center, New Haven, Connecticut
| | | | - Madhukar S. Patel
- Division of Surgical Transplantation, University of Texas Southwestern Medical Center/William P. Clements Jr. University Hospital, Dallas
| | - Shawn J. Pelletier
- Division of Transplant Surgery, University of Virginia Health System, Charlottesville
| | - Shimul A. Shah
- Department of Surgery, University Cincinnati Medical Center, Cincinnati, Ohio
| | - Parsia A. Vagefi
- Division of Surgical Transplantation, University of Texas Southwestern Medical Center/William P. Clements Jr. University Hospital, Dallas
| | - Rodrigo Vianna
- University of Miami Transplant Institute, Miami, Florida
| | - Gazi B. Zibari
- Willis Knighton Advanced Surgery Center, Willis-Knighton Health System, Shreveport, Louisiana
| | | | - Susan L. Orloff
- Division of Abdominal Organ Transplantation/Hepatobiliary Surgery, Oregon Health & Science University, Portland
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Chisholm-Burns M, Kelly BS, Spivey CA. Xenotransplantation could either be a friend or foe of healthcare equity. COMMUNICATIONS MEDICINE 2024; 4:85. [PMID: 38734795 PMCID: PMC11088630 DOI: 10.1038/s43856-024-00511-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
Chisholm-Burns et al. discuss the substantial shortage of organs available for transplantation, with disparities in access amongst some racial and ethnic groups. The authors suggest that while xenotransplantation can potentially increase organ availability, it also has the potential to further embed inequities in transplant care.
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Affiliation(s)
- Marie Chisholm-Burns
- Oregon Health & Science University, 3225 S.W. Pavilion Loop, MC: L101 Baird Hall (Suite 1011), Portland, OR, 97239, USA.
| | - Burnett S Kelly
- DCI Donor Services Inc., 3940 Industrial Blvd, West Sacramento, CA, 95691, USA
| | - Christina A Spivey
- Oregon Health & Science University, 3225 S.W. Pavilion Loop, MC: L101 Baird Hall (Suite 1011), Portland, OR, 97239, USA
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Beltrán Ponce S, Gokun Y, Douglass F, Dawson L, Miller E, Thomas CR, Pitter K, Conteh L, Diaz DA. Disparities in outcomes and access to therapy options in hepatocellular carcinoma. J Natl Cancer Inst 2024; 116:264-274. [PMID: 37831897 DOI: 10.1093/jnci/djad213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 08/10/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) disproportionately impacts racial and ethnic minorities and patients with lower socioeconomic status. These social determinants of health (SDH) lead to disparities in access to care and outcomes. We aim to understand the relationship between SDH and survival and locoregional treatment options in HCC. METHODS Using the National Cancer Database, we evaluated survival and access locoregional treatments including non-transplant surgery, liver transplant (LT), and liver-directed radiation therapy (LDRT) in patients with HCC diagnosed between 2004 and 2017. Variables including clinical stage, age, sex, race, income, rurality, year of diagnosis, facility type (FT), Charlson-Deyo score (CD), and insurance were evaluated. Cox proportional hazards multivariable regression and dominance analyses were used for analyses. RESULTS In total, 140 340 patients were included. Worse survival was seen with advanced stage, older age, Black race, rurality, public insurance, treatment at a nonacademic center, and lower income. The top predictors for survival included stage, age, and income. Completion of non-transplant surgery was best predicted by stage, FT, and insurance type, whereas LT was predicted by age, year of diagnosis, and CD score. LDRT utilization was most associated with year of diagnosis, FT, and CD score. CONCLUSION For patients with HCC, survival was predicted primarily by stage, age, and income. The primary sociodemographic factors associated with access to surgical treatments, in addition to FT, were insurance and income, highlighting the financial burdens of health care. Work is needed to address disparities in access to care, including improved insurance access, addressing financial inequities and financial toxicities of treatments, and equalizing care opportunities in community centers.
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Affiliation(s)
- Sara Beltrán Ponce
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Yevgeniya Gokun
- Secondary Data Core, Center for Biostatistics, The Ohio State University Wexner School of Medicine, Columbus, OH, USA
| | | | - Laura Dawson
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Eric Miller
- Department of Radiation Oncology, The Ohio State University Wexner School of Medicine, The James Cancer Center, Columbus, OH, USA
| | - Charles R Thomas
- Department of Radiation Oncology, Dartmouth Geisel School of Medicine, Hanover, NH, USA
| | - Kenneth Pitter
- Department of Radiation Oncology, The Ohio State University Wexner School of Medicine, The James Cancer Center, Columbus, OH, USA
| | - Lanla Conteh
- Division of Hepatology, Department of Gastroenterology, The Ohio State University Wexner School of Medicine, Columbus, OH, USA
| | - Dayssy A Diaz
- Department of Radiation Oncology, The Ohio State University Wexner School of Medicine, The James Cancer Center, Columbus, OH, USA
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Yazdanfar M, Zepeda J, Dean R, Wu J, Levy C, Goldberg D, Lammert C, Prenner S, Reddy KR, Pratt D, Forman L, Assis DN, Lytvyak E, Montano-Loza AJ, Gordon SC, Carey EJ, Ahn J, Schlansky B, Korzenik J, Karagozian R, Hameed B, Chandna S, Yu L, Bowlus CL. African American race does not confer an increased risk of clinical events in patients with primary sclerosing cholangitis. Hepatol Commun 2024; 8:e0366. [PMID: 38285883 PMCID: PMC10830082 DOI: 10.1097/hc9.0000000000000366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/01/2023] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND The natural history of primary sclerosing cholangitis (PSC) among African Americans (AA) is not well understood. METHODS Transplant-free survival and hepatic decompensation-free survival were assessed using a retrospective research registry from 16 centers throughout North America. Patients with PSC alive without liver transplantation after 2008 were included. Diagnostic delay was defined from the first abnormal liver test to the first abnormal cholangiogram/liver biopsy. Socioeconomic status was imputed by the Zip code. RESULTS Among 850 patients, 661 (77.8%) were non-Hispanic Whites (NHWs), and 85 (10.0%) were AA. There were no significant differences by race in age at diagnosis, sex, or PSC type. Inflammatory bowel disease was more common in NHWs (75.8% vs. 51.8% p=0.0001). The baseline (median, IQR) Amsterdam-Oxford Model score was lower in NHWs (14.3, 13.4-15.2 vs. 15.1, 14.1-15.7, p=0.002), but Mayo risk score (0.03, -0.8 to 1.1 vs. 0.02, -0.7 to 1.0, p=0.83), Model for End-stage Liver Disease (5.9, 2.8-10.7 vs. 6.4, 2.6-10.4, p=0.95), and cirrhosis (27.4% vs. 27.1%, p=0.95) did not differ. Race was not associated with hepatic decompensation, and after adjusting for clinical variables, neither race nor socioeconomic status was associated with transplant-free survival. Variables independently associated with death/liver transplant (HR, 95% CI) included age at diagnosis (1.04, 1.02-1.06, p<0.0001), total bilirubin (1.06, 1.04-1.08, p<0.0001), and albumin (0.44, 0.33-0.61, p<0.0001). AA race did not affect the performance of prognostic models. CONCLUSIONS AA patients with PSC have a lower rate of inflammatory bowel disease but similar progression to hepatic decompensation and liver transplant/death compared to NHWs.
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Affiliation(s)
- Maryam Yazdanfar
- Division of Gastroenterology and Hepatology, University of California Davis, Sacramento, California, USA
| | - Joseph Zepeda
- Division of Gastroenterology and Hepatology, University of California Davis, Sacramento, California, USA
| | - Richard Dean
- Division of Gastroenterology and Hepatology, University of California Davis, Sacramento, California, USA
| | - Jialin Wu
- Division of Gastroenterology and Hepatology, Schiff Center for Liver Disease, University of Miami, Miami, Florida, USA
| | - Cynthia Levy
- Division of Gastroenterology and Hepatology, Schiff Center for Liver Disease, University of Miami, Miami, Florida, USA
| | - David Goldberg
- Division of Gastroenterology and Hepatology, Schiff Center for Liver Disease, University of Miami, Miami, Florida, USA
| | | | - Stacey Prenner
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - K. Rajender Reddy
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Lisa Forman
- University of Colorado, Denver, Colorado, USA
| | | | - Ellina Lytvyak
- Division of Preventive Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Aldo J. Montano-Loza
- Division of Gastroenterology and Liver Unit, University of Alberta, Edmonton, Alberta, Canada
| | - Stuart C. Gordon
- Henry Ford Health and Wayne State University School of Medicine, Detroit, Michigan, USA
| | | | - Joseph Ahn
- Oregon Health Sciences University, Portland, Oregon, USA
| | | | | | | | - Bilal Hameed
- UC San Francisco, San Francisco, California, USA
| | | | - Lei Yu
- University of Washington, Seattle, Washington, USA
| | - Christopher L. Bowlus
- Division of Gastroenterology and Hepatology, University of California Davis, Sacramento, California, USA
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5
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Godoy-Brewer GM, Chyou D, Goldberg DS. Impact of acuity circles on racial and ethnic disparities in liver transplantation. Liver Transpl 2023; 29:1134-1137. [PMID: 37013920 DOI: 10.1097/lvt.0000000000000141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 03/20/2023] [Indexed: 04/05/2023]
Affiliation(s)
| | - Darius Chyou
- Department of Internal Medicine, University of Miami, Miami, Florida, USA
| | - David S Goldberg
- University of Miami, Division of Digestive Health and Liver Diseases, Miami, Florida, USA
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Cooper KM, Colletta A, Hathaway NJ, Liu D, Gonzalez D, Talat A, Barry C, Krishnarao A, Mehta S, Movahedi B, Martins PN, Devuni D. Delayed referral for liver transplant evaluation worsens outcomes in chronic liver disease patients requiring inpatient transplant evaluation. World J Transplant 2023; 13:169-182. [PMID: 37388395 PMCID: PMC10303412 DOI: 10.5500/wjt.v13.i4.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/21/2023] [Accepted: 06/06/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Indications to refer patients with cirrhosis for liver transplant evaluation (LTE) include hepatic decompensation or a model for end stage liver disease (MELD-Na) score ≥ 15. Few studies have evaluated how delaying referral beyond these criteria affects patient outcomes.
AIM To evaluate clinical characteristics of patients undergoing inpatient LTE and to assess the effects of delayed LTE on patient outcomes (death, transplantation).
METHODS This is a single center retrospective cohort study assessing all patients undergoing inpatient LTE (n = 159) at a large quaternary care and liver transplant center between 10/23/2017-7/31/2021. Delayed referral was defined as having prior indication (decompensation, MELD-Na ≥ 15) for LTE without referral. Early referral was defined as referrals made within 3 mo of having an indication based on practice guidelines. Logistic regression and Cox Hazard Regression were used to evaluate the relationship between delayed referral and patient outcomes.
RESULTS Many patients who require expedited inpatient LTE had delayed referrals. Misconceptions regarding transplant candidacy were a leading cause of delayed referral. Ultimately, delayed referrals negatively affected overall patient outcome and an independent predictor of both death and not receiving a transplant. Delayed referral was associated with a 2.5 hazard risk of death.
CONCLUSION Beyond initial access to an liver transplant (LT) center, delaying LTE increases risk of death and reduces risk of LT in patients with chronic liver disease. There is substantial opportunity to increase the percentage of patients undergoing LTE when first clinically indicated. It is crucial for providers to remain informed about the latest guidelines on liver transplant candidacy and the transplant referral process.
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Affiliation(s)
- Katherine M Cooper
- Department of Medicine, UMass Chan Medical School, Worcester, MA 01605, United States
| | - Alessandro Colletta
- Department of Medicine, UMass Chan Medical School, Worcester, MA 01605, United States
| | - Nicholas J Hathaway
- Department of Medicine, UMass Chan Medical School, Worcester, MA 01605, United States
| | - Diana Liu
- Department of Medicine, UMass Chan Medical School, Worcester, MA 01605, United States
| | - Daniella Gonzalez
- Department of Medicine, UMass Chan Medical School, Worcester, MA 01605, United States
| | - Arslan Talat
- Department of Medicine, Division of Gastroenterology, UMass Chan Medical School, Worcester, MA 01605, United States
| | - Curtis Barry
- Department of Medicine, Division of Gastroenterology, UMass Chan Medical School, Worcester, MA 01605, United States
| | - Anita Krishnarao
- Department of Medicine, Division of Gastroenterology, UMass Chan Medical School, Worcester, MA 01605, United States
| | - Savant Mehta
- Department of Medicine, Division of Gastroenterology, UMass Chan Medical School, Worcester, MA 01605, United States
| | - Babak Movahedi
- Department of Surgery, Transplant Division, UMass Chan Medical School, Worcester, MA 01605, United States
| | - Paulo N Martins
- Department of Surgery, Transplant Division, UMass Chan Medical School, Worcester, MA 01605, United States
| | - Deepika Devuni
- Department of Medicine, Division of Gastroenterology, UMass Chan Medical School, Worcester, MA 01605, United States
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7
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Althoff AL, Ali MS, O'Sullivan DM, Dar W, Emmanuel B, Morgan G, Einstein M, Richardson E, Sotil E, Swales C, Sheiner PA, Serrano OK. Short- and Long-Term Outcomes for Ethnic Minorities in the United States After Liver Transplantation: Parsing the Hispanic Paradox. Transplant Proc 2022; 54:2263-2269. [DOI: 10.1016/j.transproceed.2022.08.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 08/03/2022] [Accepted: 08/26/2022] [Indexed: 11/05/2022]
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8
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Schappe T, Peskoe S, Bhavsar N, Boulware LE, Pendergast J, McElroy LM. Geospatial Analysis of Organ Transplant Referral Regions. JAMA Netw Open 2022; 5:e2231863. [PMID: 36107423 PMCID: PMC9478781 DOI: 10.1001/jamanetworkopen.2022.31863] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
IMPORTANCE System and center-level interventions to improve health equity in organ transplantation benefit from robust characterization of the referral population served by each transplant center. Transplant referral regions (TRRs) define geographic catchment areas for transplant centers in the US, but accurately characterizing the demographics of populations within TRRs using US Census data poses a challenge. OBJECTIVE To compare 2 methods of linking US Census data with TRRs-a geospatial intersection method and a zip code cross-reference method. DESIGN, SETTING, AND PARTICIPANTS This cohort study compared spatial congruence of spatial intersection and zip code cross-reference methods of characterizing TRRs at the census block level. Data included adults aged 18 years and older on the waiting list for kidney transplant from 2008 through 2018. EXPOSURES End-stage kidney disease. MAIN OUTCOMES AND MEASURES Multiple assignments, where a census tract or block group crossed the boundary between 2 hospital referral regions and was assigned to multiple different TRRs; misassigned area, the portion of census tracts or block groups assigned to a TRR using either method but fall outside of the TRR boundary. RESULTS In total, 102 TRRs were defined for 238 transplant centers. The zip code cross-reference method resulted in 4627 multiple-assigned census block groups (representing 18% of US land area assigned to TRRs), while the spatial intersection method eliminated this problem. Furthermore, the spatial method resulted in a mean and median reduction in misassigned area of 65% and 83% across all TRRs, respectively, compared with the zip code cross-reference method. CONCLUSIONS AND RELEVANCE In this study, characterizing populations within TRRs with census block groups provided high spatial resolution, complete coverage of the country, and balanced population counts. A spatial intersection approach avoided errors due to duplicative and incorrect assignments, and allowed more detailed and accurate characterization of the sociodemographics of populations within TRRs; this approach can enrich transplant center knowledge of local referral populations, assist researchers in understanding how social determinants of health may factor into access to transplant, and inform interventions to improve heath equity.
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Affiliation(s)
- Tyler Schappe
- Duke University, School of Medicine, Durham, North Carolina
| | - Sarah Peskoe
- Duke University, School of Medicine, Durham, North Carolina
| | - Nrupen Bhavsar
- Duke University, School of Medicine, Durham, North Carolina
| | | | | | - Lisa M McElroy
- Duke University, School of Medicine, Durham, North Carolina
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9
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The Transplant Trolley Problem. Camb Q Healthc Ethics 2022; 31:281-284. [PMID: 35899539 DOI: 10.1017/s0963180121000980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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10
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Martins PN, Kim IK. Editorial: Disparities in transplantation access and outcomes: mind the gap! Curr Opin Organ Transplant 2021; 26:498-500. [PMID: 34402456 DOI: 10.1097/mot.0000000000000919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Organ transplantation still remains a problem of supply and demand and presents multiple ethical challenges to our society. Despite numerous targeted interventions and policy reforms, women, underrepresented minorities and patients with low socioeconomic status (SES) continue to have unequal access to transplant. The purpose of this special edition is to highlight disparities in access to transplantation and posttransplant outcomes. Acknowledging that these disparities exist is the first step toward interventions aimed at mitigating this long-standing inequity. This issue provides 10 articles that give the background and summarize relevant literature describing these disparities and identify potential areas of intervention. Most of the data relates to the United States but may reflect patterns encounter in most societies. Each manuscript was written by leaders of international teams in the field of patient advocacy, public health or outcome research in transplantation.
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Affiliation(s)
- Paulo N Martins
- Dept of Surgery, Division of Transplantation, University of Massachusetts, Worcester, Massachusetts
| | - Irene K Kim
- Comprehensive Transplant Center, Cedars-Sinai, Los Angeles, California, USA
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