Geographic disparities in access to organ transplant in France.
BACKGROUND
Allocation of organs is organized on a regional basis in France. We assessed regional differences in access to organ transplant.


METHODS
We used the recipient database and the waiting list database from the year 1994 onward. We estimated median waiting time by region and organ. The probability of receiving a transplant was estimated using the Kaplan-Meier method. Between-region comparisons used the log-rank test, with adjustment for blood type and disease category.


RESULTS
At the end of a 4-month follow-up period, 49% of 3,553 patients had received transplants: 64% of 797 benefited from liver transplants, 52% of 549 from heart transplants, and 22% of 2,207 from kidney transplants. Death rates on the waiting lists were 10%, 14%, and 1% for patients selected for liver, heart, and kidney transplant, respectively. Transplantation percentage (all organs) decreased from 63% in the West to 43% in the Paris region and mortality increased from 2% in the West to 7% in the Southeast. All tests of inter-regional differences were statistically significant.


CONCLUSIONS
Factors explaining geographic differences related to the background of transplant teams, activity of organ procurement, and severity of patients on the list.
Roudot-Thoraval
Françoise
F
Public Health, Henri Mondor, AP-HP, Paris, France.
Romano
Philippe
P
Spaak
Francis
F
Houssin
Didier
D
Durand-Zaleski
Isabelle
I
D002102:Cadaver; D005602:France; D005843:Geography; D016027:Heart Transplantation / Q000706:statistics & numerical data*; D006801:Humans; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D013997:Time Factors; D014019:Tissue Donors / Q000706:statistics & numerical data / Q000600:supply & distribution*; D014850:Waiting Lists