Parikh Neehar D, Marrero Wesley J, Sonnenday Christopher J, Lok Anna S, Hutton David W, Lavieri Mariel S
1 Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI.2 Industrial and Operational Engineering, University of Michigan, Ann Arbor, MI.3 Department of Surgery, University of Michigan, Ann Arbor, MI.4 School of Public Health, University of Michigan Ann Arbor, MI.
Transplantation. 2017 Sep;101(9):2048-2055. doi: 10.1097/TP.0000000000001785.
To reduce the geographic heterogeneity in liver transplant allocation, the United Network of Organ Sharing has proposed redistricting, which is impacted by both donor supply and liver transplantation demand. We aimed to determine the impact of demographic changes on the redistricting proposal and characterize causes behind geographic heterogeneity in donor supply.
We analyzed adult donors from 2002 to 2014 from the United Network of Organ Sharing database and calculated regional liver donation and utilization stratified by age, race, and body mass index. We used US population data to make regional projections of available donors from 2016 to 2025, incorporating the proposed 8-region redistricting plan. We used donors/100 000 population age 18 to 84 years (D/100K) as a measure of equity. We calculated a coefficient of variation (standard deviation/mean) for each regional model. We performed an exploratory analysis where we used national rates of donation, utilization and both for each regional model.
The overall projected D/100K will decrease from 2.53 to 2.49 from 2016 to 2025. The coefficient of variation in 2016 is expected to be 20.3% in the 11-region model and 13.2% in the 8-region model. We found that standardizing regional donation and utilization rates would reduce geographic heterogeneity to 4.9% in the 8-region model and 4.6% in the 11-region model.
The 8-region allocation model will reduce geographic variation in donor supply to a significant extent; however, we project that geographic disparity will marginally increase over time. Though challenging, interventions to better standardize donation and utilization rates would be impactful in reducing geographic heterogeneity in organ supply.
为减少肝移植分配中的地域异质性，器官共享联合网络（United Network of Organ Sharing）提出了重新划分区域的建议，该建议受到供体供应和肝移植需求的双重影响。我们旨在确定人口结构变化对重新划分区域建议的影响，并描述供体供应地域异质性背后的原因。
我们分析了器官共享联合网络数据库中2002年至2014年的成年供体，并按年龄、种族和体重指数对区域肝脏捐赠和利用情况进行了分层计算。我们使用美国人口数据对2016年至2025年的可用供体进行区域预测，并纳入了提议的8区域重新划分计划。我们将18至84岁人群中每10万人的供体数量（D/100K）作为公平性的衡量标准。我们为每个区域模型计算了变异系数（标准差/均值）。我们进行了一项探索性分析，在分析中我们使用了每个区域模型的全国捐赠率、利用率以及两者的数据。
预计从2016年到2025年，总体预测的D/100K将从2.53降至2.49。2016年，11区域模型的变异系数预计为20.3%，8区域模型为13.2%。我们发现，对区域捐赠率和利用率进行标准化将使8区域模型中的地域异质性降至4.9%，11区域模型中降至4.6%。
8区域分配模型将在很大程度上减少供体供应的地域差异；然而，我们预计随着时间的推移，地域差距将略有增加。尽管具有挑战性，但更好地标准化捐赠率和利用率的干预措施将对减少器官供应的地域异质性产生影响。
