In Reply We concur with Dr Gunnar that distance-related inequities in access to liver transplantation are not unique to the VHA. However, the absence of robust national databases precludes such evaluations in the non-VA population. The VHA’s integrated electronic medical record allowed us to use the VHA as a model of the effects of centralization and there was no intent to imply that these are VHA-specific disparities. Unlike private centers, the VHA attempts to minimize the additional burden of distance by providing travel assistance to veterans and caregivers; however, such support does not ameliorate the reduced access to transplantation for veterans living more than 100 miles from a VATC.
Kaplan DE, Goldberg DS. Liver Transplants Among US Veterans—Reply. JAMA. 2014;312(4):437. doi:10.1001/jama.2014.7158