title: Outcomes and disparities in liver transplantation will be improved by redistricting-cons.
abstract: OBJECTIVE
  Over the last 2 years, the liver transplant community has been debating a proposal to redraw the maps of organ distribution. The basis for these proposed changes is reported disparities in severity of illness at transplantation across the USA - however, this is based on the allocation model for end-stage liver disease score. In this review, we provide a critical overview of the redistribution proposal, its flaws and how it may worsen outcomes and exacerbate disparities in liver transplantation.
  
  
  RESULTS
  The main findings we highlight are data questioning the disparity metric used to justify the redistribution. We also review data published in recent articles and presented at public forums questioning whether there truly are disparities in access to transplant care among the broader population with liver disease, and whether disparities even getting to the waitlist are important and not to be ignored.
  
  
  CONCLUSIONS
  This review article highlights major methodological and policy flaws with the current redistribution proposal. We demonstrate how the waitlist disparities that the proposal is intended to fix are not as they seem. Furthermore, if this proposal is passed, outcomes of liver transplantation nationally may worsen, and disparities for those with limited access to healthcare will worsen.
authors.affiliation: aDivision of Gastroenterology, University of Pennsylvania School of Medicine bCenter for Clinical Epidemiology and Biostatistics, University of Pennsylvania cLeonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania dDepartment of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: David Seth
authors.initials: DS
authors.lastname: Goldberg
authors.forename: Seth
authors.initials: S
authors.lastname: Karp
mesh_terms: D054625:Healthcare Disparities; D006801:Humans; D016031:Liver Transplantation / Q000379:methods*; D009927:Tissue and Organ Procurement / Q000379:methods*; D016896:Treatment Outcome