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Invited Commentary
May 20, 2020

Sex Does Matter in Liver Allocation—Time to Address Existing Sex-Based Disparities

Author Affiliations
  • 1Division of Gastrointestinal and Hepatology, Department of Medicine, Oregon Health and Science University, Portland
  • 2Division of Abdominal Organ Transplant, Department of Surgery, Oregon Health and Science University, Portland
  • 3Department of Molecular Microbiology and Immunology, Oregon Health & Science University, Portland
JAMA Surg. Published online May 20, 2020. doi:10.1001/jamasurg.2020.1130

Sex-based disparities in solid organ transplant exist in every studied phase of the endeavor, from patient access to outcomes1 to the physicians performing the operations.2 In this issue of JAMA Surgery, Locke et al3 present a retrospective analysis of the United Network for Organ Sharing database that confirms previously published sex-based disparities in liver transplant while adding a shrewd analysis of the components that lead to these disparities. Distressingly (although not surprisingly), they found that women were more likely than men (by 9%) to die on the liver transplant waiting list and less likely (by 14%) to receive a deceased-donor liver transplant. Careful analysis of component contribution to these numbers revealed that Model for End-stage Liver Disease (MELD) factors (eg, creatinine) and candidate body size played large parts in the noted sex inequalities, while geographic factors played a far smaller role. Based on these findings, the authors suggest a more comprehensive approach to fixing inequalities in organ allocation than one simply based on geographical concerns.

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