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Moving past “think local, act global”: A perspective on geographic disparity
Author(s) -
Lynch Raymond J.,
Magliocca Joseph F.,
Hundley Jonathan C.,
Karp Seth J.
Publication year - 2019
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.15079
Subject(s) - socioeconomic status , statutory law , poverty , liver transplantation , inequality , medicine , organ donation , distribution (mathematics) , health equity , health care , transplantation , public economics , development economics , environmental health , actuarial science , economic growth , political science , law , economics , population , surgery , mathematical analysis , mathematics
The transplant community has debated the necessity and merits of broader organ distribution for several years, but the debate has been fundamentally shaped by inaccurate assessments of donor supply and demand. The possible legal requirements of distribution must be balanced with (a) the moral and statutory imperatives to reduce inequities resulting from socioeconomic disparity, and (b) the shortcomings of MELD in predicting mortality risk in rural areas. In this viewpoint, we use the example of liver transplantation to discuss the drivers of geographic disparity as a direct consequence of donation rates, local organ use, wealth, and poverty. Seen in this light, strategies seeking to equalize MELD at transplant across the United States risk severely exacerbating existing inequalities in access to health care.