title: Liver sharing and organ procurement organization performance under redistricted allocation.
abstract: Concerns have been raised that optimized redistricting of liver allocation areas might have the unintended result of shifting livers from better-performing to poorer-performing organ procurement organizations (OPOs). We used liver simulated allocation modeling to simulate a 5-year period of liver sharing within either 4 or 8 optimized districts. We investigated whether each OPO's net liver import under redistricting would be correlated with 2 OPO performance metrics (observed to expected liver yield and liver donor conversion ratio), along with 2 other potential correlates (eligible deaths and incident listings above a Model for End-Stage Liver Disease score of 15). We found no evidence that livers would flow from better-performing OPOs to poorer-performing OPOs in either redistricting scenario. Instead, under these optimized redistricting plans, our simulations suggest that livers would flow from OPOs with more-than-expected eligible deaths toward those with fewer-than-expected eligible deaths and that livers would flow from OPOs with fewer-than-expected incident listings to those with more-than-expected incident listings; the latter is a pattern that is already established in the current allocation system. Redistricting liver distribution to reduce geographic inequity is expected to align liver allocation across the country with the distribution of supply and demand rather than transferring livers from better-performing OPOs to poorer-performing OPOs.
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.|Department of Mathematics, United States Naval Academy, Annapolis, MD.
authors.forename: Sommer E
authors.initials: SE
authors.lastname: Gentry
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Eric K H
authors.initials: EK
authors.lastname: Chow
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.|Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD.
authors.forename: Allan
authors.initials: A
authors.lastname: Massie
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Xun
authors.initials: X
authors.lastname: Luo
authors.affiliation: Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN.
authors.forename: Eugene
authors.initials: E
authors.lastname: Shteyn
authors.affiliation: Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN.
authors.forename: Joshua
authors.initials: J
authors.lastname: Pyke
authors.affiliation: Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN.
authors.forename: David
authors.initials: D
authors.lastname: Zaun
authors.affiliation: Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN.|Departments of Epidemiology and Community Health, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN.
authors.forename: Jon J
authors.initials: JJ
authors.lastname: Snyder
authors.affiliation: Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN.|Departments of Epidemiology and Community Health, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN.|Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN.
authors.forename: Ajay K
authors.initials: AK
authors.lastname: Israni
authors.affiliation: Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN.|Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN.
authors.forename: Bert
authors.initials: B
authors.lastname: Kasiske
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.|Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD.
authors.forename: Dorry L
authors.initials: DL
authors.lastname: Segev
mesh_terms: D002391:Catchment Area, Health; D003198:Computer Simulation; D003695:Delivery of Health Care; D015276:Health Care Rationing; D006301:Health Services Needs and Demand; D054625:Healthcare Disparities; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008962:Models, Theoretical; D020380:Needs Assessment; D017064:Process Assessment, Health Care; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement / Q000379:methods*; D016896:Treatment Outcome; D014850:Waiting Lists