Addressing Geographic Disparities in Liver Transplantation Through Redistricting

摘要: Severe geographic disparities exist in liver transplantation; for patients with comparable disease severity, 90-day transplant rates range from 18% to 86% and death 14% 82% across donation service areas (DSAs). Broader sharing has been proposed resolve inequity; however, we hypothesized that the efficacy of broader depends on partitions used. To determine potential impact redistricting disparity severity at transplantation, combined existing DSAs into novel regions using mathematical optimization. Optimized maps current were evaluated Liver Simulated Allocation Model. Primary analysis was based 6700 deceased donors, 28 063 candidates, 242 727 Model End-Stage Disease (MELD) changes 2010. Fully regional within map would paradoxically worsen (variance MELD transplantation increases 11.2 13.5, p = 0.021), although it decrease waitlist deaths (from 1368 1329, p = 0.002). In contrast, an optimized significantly reduce (to 7.0, p = 0.002) while achieving a larger 1307, Redistricting optimization, but not alone, allocation livers United States.