Liver Sharing and Organ Procurement Organization Performance under Redistricted Allocation

摘要

Concerns have been raised that optimized redistricting of liver allocation areas might have the unintended result of shifting livers from better-performing to poorer-performing OPOs. We used the Liver Simulated Allocation Model to simulate a 5-year period of liver sharing within either 4 or 8 optimized districts. We investigated whether each OPO’s net liver import under redistricting would be correlated with two OPO performance metrics (observed to expected liver yield and liver donor conversion ratio), along with two other potential correlates (eligible deaths and incident listings above MELD 15). We found no evidence that livers would flow from better-performing OPOs to poorer-performing OPOs in either redistricting scenario. Instead, under these optimized redistricting plans, our simulations suggest that livers would flow from OPOs with more-than-expected eligible deaths toward those with fewer-than-expected eligible deaths, and that livers would flow from OPOs with fewer-than-expected incident listings to those with more-than-expected incident listings, the latter a pattern already established in the current allocation system. Redistricting liver distribution to reduce geographic inequity is expected to align liver allocation across the country with the distribution of supply and demand, rather than transferring livers from better-performing OPOs to poorer-performing OPOs.