A patient’s eligibility to receive an organ transplant is determined by, among other things, the patient’s location and consequently, geographic borders have been routinely blamed as the predominate cause of inequality among transplant care. However, the Perelman School of Medicine at the University of Pennsylvania recently found that transplant center variability in deciding whether to accept an organ may also play a role in such inequality and waitlist mortality.
As explained by the study, a Model for End-Stage Liver Disease (MELD) score is used to prioritize patients on the liver transplant list. Despite this uniform system, there remain disparities among the 11 Organ Procurement and Transplantation Network (OPTN) regions across the United States. When an organ becomes available, the United Network for Organ Sharing (UNOS) ranks all patients eligible to receive the organ based on blood-type match, the recipient’s geographic location, MELD score and the recipient’s willingness to accept organs with certain unfavorable characteristics. The organ is then offered at a transplant center at which the highest-ranked patient is waitlisted. The center may in turn decline the organ based on donor age, donor-recipient size mismatch, or a decision that a patient with lower priority has a greater risk of death and is therefore a better recipient for that particular organ. Perelman’s study found significant variability in the organ acceptance rate among transplant centers, with some accepting organs for their first-ranked patients as low as 16% of the time to as high as 58% of the time, even after adjusting for donor, recipient, and transplant center characteristics.
A center’s decision to accept an organ is a matter of life and death. In order to reduce the variability in such decision-making among transplant centers, and maximize access to lifesaving transplant care, the study suggests that organ acceptance rates of all transplant centers should be made public so that patients and referring providers can make informed decisions when selecting a center for their care.