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June 3, 2020

Exacerbating Racial Disparities in Kidney Transplant: The Consequences of Geographic Redistribution

Author Affiliations
  • 1University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham
JAMA Surg. Published online June 3, 2020. doi:10.1001/jamasurg.2020.1455

Suppose for a moment that you had advanced warning a 737 jetliner with 237 people on board had a 90% probability of crashing and killing all 237 passengers and crew, along with 13 people on the ground. Would you cancel the flight?

Recently, a policy for the geographic redistribution of kidneys for transplant in the US has been approved by the Organ Procurement and Transplant Network (OPTN) board of directors. This policy was proposed upon the direction of the Secretary of the US Department of Health and Human Services and motivated by the requirement to comply with the Final Rule, which stipulates “organs and tissues ought to be distributed on the basis of objective priority criteria, and not on accidents of geography.”1 Previous studies using OPTN data concluded that geographic disparity exists across the US in access to kidney transplant, suggesting that where a person lives is associated with their access to transplant,2 and provided the rationale for redefining geographic proximity in organ sharing from donor service areas and regions to a 250–nautical mile radius around the donor hospital. The overarching goal was to develop a new allocation system capable of equalizing kidney transplant rates across the US.

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