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Comment & Response
July 23/30, 2014

Liver Transplants Among US Veterans—Reply

Author Affiliations
  • 1Gastroenterology Section, Philadelphia VA Medical Center, Philadelphia, Pennsylvania
  • 2Division of Gastroenterology, Department of Medicine, University of Pennsylvania, Philadelphia

Copyright 2014 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA. 2014;312(4):437. doi:10.1001/jama.2014.7158

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.

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