title: Fair is fair: We must re-allocate livers for transplant.
abstract: The 11 original regions for organ allocation in the United States were determined by proximity between hospitals that provided deceased donors and transplant programs. As liver transplants became more successful and demand rose, livers became a scarce resource. A national system has been implemented to prioritize liver allocation according to disease severity, but the system still operates within the original procurement regions, some of which have significantly more deceased donor livers. Although each region prioritizes its sickest patients to be liver transplant recipients, the sickest in less liver-scarce regions get transplants much sooner and are at far lower risk of death than the sickest in more liver-scarce regions. This has resulted in drastic and inequitable regional variation in preventable liver disease related death rate.A new region districting proposal - an eight district model - has been carefully designed to reduce geographic inequities, but is being fought by many transplant centers that face less scarcity under the current model. The arguments put forth against the new proposal, couched in terms of fairness and safety, will be examined to show that the new system is technologically feasible, will save more lives, and will not worsen socioeconomic disparity. While the new model is likely not perfect, it is a necessary step toward fair allocation.
authors.affiliation: Applied Bioethics, NYU School of Professional Studies, 7 East 12th Street, Rm 825b, New York, NY, 10003, USA. Brendan.parent@nyu.edu.
authors.forename: Brendan
authors.identifier: 0000-0003-3057-5684
authors.initials: B
authors.lastname: Parent
authors.affiliation: Department of Population Health, Medical Ethics, NYU School of Medicine, 227 East 30th Street, Rm 722, New York, NY, 10016, USA.
authors.forename: Arthur L
authors.initials: AL
authors.lastname: Caplan
mesh_terms: D006078:Government Programs; D000069576:Health Equity; D054625:Healthcare Disparities; D006761:Hospitals; D006801:Humans; D008099:Liver / Q000601:surgery*; D008107:Liver Diseases / Q000601:surgery*; D016031:Liver Transplantation / Q000941:ethics*; D012449:Safety; D012720:Severity of Illness Index; D012935:Social Justice; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000941:ethics*; D014481:United States
keywords: Allocation; Fairness; Justice; Liver transplant; Median MELD; Organ procurement organizations; Transplant ethics