Demographic Variations of Income, Race, and Healthcare Access and Their Relationship to Donor Organ Allocation: Potential Impact of Redistricting.

Abstract

While geographic disparities in access to liver transplantation violate federal laws and should be addressed in revised organ allocation policies, equity in access across all racial and socioeconomic groups must also be considered in any redistricting proposal. We evaluated the potential impact of redistricting with respect to SES, race, disease burden and access to healthcare on UNOS Region 3 (Southeast). The Southeast has a higher incidence of liver failure compared to other parts of the country, which suggests a greater need for transplant. Region 3 of UNOS according to CDC data (liver disease mortality) has an incidence rate of 10.8 (per 100,000) compared to 9.1 in region 1 and 10.3 in the US overall. By race, 28.8% of Region 3 donors are AA compared to 14% of donors nationally. Among transplant recipients, a larger percentage of patients are AA in Region 3 (14.1%) versus nationally (11.2%). Nationally, AA patients receive liver transplants at a higher mean MELD score, 23 vs. 21, compared to Whites. AA patients are also listed at a higher MELD score than Whites (20 vs. 17). By SES, 13.7% of UNOS region 3 listed patients live below the federal poverty level compared to 12.3% nationally. With respect to health care access, AA patients, who primarily live in the Southeast, have a higher percentage (17.3%) living below the federal poverty level compared to Whites (10.3%) in the U.S. Additionally, median income by zip code for US recipients was $45,500 while region 3 recipients had a median income of $41,000. These data do not take into account the possibility that a significant number of patients living below the FPL may never be evaluated for liver transplantation due to poor access to healthcare. While broader sharing of livers through redistricting may reduce geographic disparities in liver transplantation, it is unclear how this change may impact access to liver transplantation among racial/ethnic minorities and patients with lower SES. Policy makers should consider that racial and socioeconomic disparities could increase if more organs are retrieved from the Southeast and utilized in the Northeast.