The Impact of the Share 35 Policy on Racial and Ethnic Disparities in Access to Liver Transplantation for Patients with End Stage Liver Disease in the United States: An Analysis from UNOS Database.
The Share 35 policy was instituted in June 2013 by the United Network for Organ Sharing (UNOS) in order to reduce death on liver transplant waiting list. The effect of this policy on racial and ethnic disparities in access to liver transplantation has not been examined.



A total of 14,585 adult patients registered for liver transplantation between 2012 and 2015 were identified from UNOS database. Logistic and proportional hazards models were used to model the effects of race and ethnicity on access to liver transplantation. Stratification on pre- and post-Share 35 periods was performed to compare the first 18 months of Share 35 policy to an equivalent time period before.



Comparison of the pre- and post-Share 35 periods showed significantly decreased time on waiting list and increased numbers of minorities having access to liver transplantation. Hispanic recipients still experienced significantly longer waiting time (HR: 0.69, 95% CI: 0.53-0.88) before they received liver transplantation after Share 35 policy took effect.



The Share 35 policy did not lead to improved access to liver transplantation among minorities but eliminated the previously observed racial and ethnic disparities in transplant rates as well as shortened the waiting time.
Department of Biostatistics, School of Public Health, University of Texas Health Science Center at Houston, 1200 Pressler Street, RAS-E803f, Houston, TX, 77030, USA. Yefei.Zhang@uth.tmc.edu.
Yefei
Y
Zhang
D000368:Aged; D003299:Cooperative Behavior; D058625:End Stage Liver Disease / Q000208:ethnology* / Q000601:surgery; D005006:Ethnicity; D005260:Female; D006291:Health Policy; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006630:Hispanic or Latino; D006801:Humans; D008099:Liver; D016031:Liver Transplantation; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008913:Minority Groups; D044469:Racial Groups; D009927:Tissue and Organ Procurement; D014481:United States; D014850:Waiting Lists
Liver transplantation; Racial and ethnic disparities; Share 35 policy; United Network for Organ Sharing