This nine-part series examined key policy issues in three aspects of organ transplantation: organ allocation, deceased donation and living donation. Access to transplants, especially kidney and liver transplants, depends on where patients live, a data analysis showed.
The average wait for a kidney in Chicago is more than six years. In Madison, Wisconsin, a 2.5-hour drive away, it’s a year and a half. People with money can travel to places with shorter wait times, but this adds a socioeconomic disparity to the geographic disparities.
Regulators’ emphasis on transplant success rates could be exacerbating the geographic disparities by causing some transplant programs to become more conservative in selecting organs and recipients. Despite a policy in 2013 requiring broader sharing of livers, significant variation in access to liver transplants remains. Policymakers are considering a proposal for even broader sharing that pits high-density parts of the country against more rural areas.
A new kidney allocation system helps healthier patients get better kidneys, but it doesn’t address geographic disparities in access to kidney transplants. Rates of donation after circulatory death, an alternative to the more common donation after brain death, vary greatly around the country. If more hospitals aggressively pursued the procedure, 16,000 more transplants could be done annually, a study found. Policymakers are considering imminent death donation, in which organs would be recovered just before life support is removed, which raises ethical questions.
A new organ preservation technique could allow the use of many organs now discarded or not recovered. Living organ donors are rarely tracked more than two years, so little data is available on their long-term complications.
Regulators have taken steps to make living donors more aware of their risks, but critics say their safety is still in the hands of transplant programs that profit from doing transplants. No national registry of living donors exists.
Many living donors lose wages and incur other costs in order to help others. Policymakers are looking at reimbursing more of those costs — or even paying donors, which raises ethical questions — to encourage more living donation. Meanwhile, transplant chains are helping more patients find matched living donors.