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Invited Commentary
May 26, 2021

Allocating/Rationing Organs for Transplant: Filling More Life Rafts vs Rearranging the Deck Chairs

Author Affiliations
  • 1Department of Surgery, University of Florida, Gainesville
  • 2Division of Transplant and Hepatobiliary Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
JAMA Surg. 2021;156(7):646. doi:10.1001/jamasurg.2021.1496

Unintended consequences are inherent in any organ allocation system. In this issue of JAMA Surgery, DuBay et al1 illustrate how the new deceased donor kidney transplant distribution change, using 250–nautical mile circles from the donor hospital as the first level of allocation, may decrease deceased donor transplant opportunities in areas of the US with a higher population burden of end-stage kidney disease (ESKD). They use the total population of patients with ESKD, with a sensitivity analysis including those younger than 70 years as a measure of transplant candidacy potential, and demonstrate that this new allocation policy widens the disparity of transplants relative to a state’s ESKD burden in many instances. They highlight the increased availability of kidney transplantation in the New York City donor service area (DSA) compared with the state of Nevada under their metric.

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