Abstract

Disparities in Access to Kidney Transplantation Between Donor Services Areas in Texas by Lewis et al is a clarion call for wider geographic sharing of donated kidneys in this country (1). The arbitrary boundaries of donor service areas (DSAs) are the impediment to equitable access for patients and Texas, although not unique, is a case study in how gerrymandering DSAs to serve individual transplant center agendas results in disenfranchisement of patients. However, eliminating geographic disparity is more than erasing DSAs boundaries, and while we agree with the sentiment expressed by the authors,we disagree that the solution is to consolidate the organ procurement organizations (OPOs) existing within a state’s borders into one. Fixing the geographic disparity that exists in kidney transplantation requires doing what is in the best interest of patients and understanding how the transplant profession must justify the trust society places in it for the stewardship of a precious national resource.

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