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Learning Objective 1: The learner will be able to explore the effect of race, gender and geographical location on access to liver transplantation in the United States.
Learning Objective 2: The learner will be able to explore opportunities to influence health care policy from a global perspective.
To increase the understanding and the effect of specific predisposing, enabling and need variables on access to liver transplantation.
Methods:
Kaplan Meir survival and Cox Proportional Hazard regression analyses were conducted using secondary data from the US Scientific Research Transplant Registry (SRTR), managed by the Organ Procurement Transplant Network and the United Network of Organ Sharing that included 32,566 patients.
Database
United States Scientific Research Transplant Registry (SRTR), with input from the US federally designated Organ Procurement Transplant Network (OPTN).
Population
Individuals wait-listed for a cadaveric liver transplant in the US from February 27, 2002 through November 30, 2007 excluding patients younger than 18 years of age, in acute liver failure or who had previously received a liver transplant.
Data Analysis
Descriptive statistics regarding those liver transplant recipients and candidates who continue to wait during the time-frame studied. The population is described in relation to those predisposing, enabling and need variables described by Anderson (1995) to explain or predict access to liver transplantation. Multivariate Cox Regression Models were used to investigate the effects of the defined variables on hazard of transplant during the time frame (2002-2007). Two Cox Regression Models were run to evaluate the effect of the MELD 15 Share Rule on hazard of transplantation at higher acuities within the US national system and separately by designated region.
Results:
Despite the implementation of an acuity based model of liver allocation, disparities in gender, race and geographical region exist.
Conclusion:
There are differences in gender, race and geographical region in the current era of liver allocation in the United States. Despite increased transplantation rates for those of greater acuity, disparities still exist nationally overall and within the 11 UNOS regions. These disparities suggest the need for an evaluation of the US federally mandated system of cadaveric liver allocation.
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