Stuart Sweet, M.D., Ph.D., is President of the OPTN/UNOS Board of Directors.
I am writing to bring you up to date on steps the OPTN has taken toward addressing geographic disparity in liver transplantation. This issue is important to each of us in the donation and transplant community.
At its December meeting, the OPTN Board, recognizing our responsibility to address this issue in a timely manner, authorized convening a stakeholder meeting to identify areas of consensus and thereby generate recommendations to the OPTN Liver and Intestine Transplantation Committee for consideration. I would like to personally thank each of the attendees* (listed below) who met by teleconference and then in person in January. The collegial atmosphere and commitment to compromise was extraordinary. Together, the group made the following recommendations for the Committee’s consideration:
- Measurements of supply and demand used to define geographic disparity and as inputs to optimization models should be independent of DSA procurement performance and transplant center listing practices
- Metrics used to assess efficacy of proposed solutions should not be limited to MELD at transplant
- Metrics should include assessment of organ utilization and the effect on patients in medically underserved areas and small volume DSAs
- Logistical changes necessary to address challenges of broader sharing should be in place prior to implementation
- All potential solutions, including those currently under consideration, should be reassessed in light of the updated supply and demand measures
- Phased implementation strategies should be considered in order to minimize unintended consequences, ease financial impacts, and mitigate sudden disruptions in logistical or contractual matters
The OPTN Liver and Intestine Transplantation Committee has reviewed these recommendations and accepted this path forward to best address the requirements of the OPTN final rule. As such, the Committee has started work on identifying appropriate new supply and demand measures. Supply/demand maps based on these measures will be available soon. Updated SRTR draft results of concentric circle, DSA neighborhood, and optimized district models will be provided to the Committee in May, and the Committee will consider these models in light of the above recommendations.
It is time for the donation and transplant community to find a solution to address geographic disparity in access to liver transplantation. For the best interest of all patients, it is time to focus on opportunities for working together on this path forward.
I am optimistic that the steps we have taken will lead to an effective solution and look forward to providing you with further updates this spring.
Yolanda Becker, Anil Chandraker, Will Chapman, Sandy Florman, Melissa Greenwald, Rick Hasz, Julie Heimbach, Ryo Hirose, Seth Karp, Goran Klintmalm, Christopher Marsh, Kevin O’Connor, Susan Orloff, Stuart Sweet, Lew Teperman, Betsy Walsh, James Alcorn, Katrina Fontenla, Ann Harper, Dave Klassen and Brian Shepard