Geography bias to US transplants24th June 2006
America's national organ transplant system has for years taken pride in directing organs to those patients who have suffered most or longest. But an investigation by the Los Angeles Times has found that whether and when patients receive donated organs depends in huge measure on where they live.
This principle of fairness is so crucial that violations have forced three California transplant programs to close in the last seven months. And yet a single, capricious factor remains pivotal in determining whether and when patients get organ transplants at all: where they live.
For transplantation purposes, the United States comprises 58 territories, each with its own supply and demand for transplanted organs. To protect local access to organs, most donated within a territory go to patients waiting there, even if sicker patients are waiting elsewhere. But supply and demand are distributed unevenly across the country, and this, the study found, has led to huge disparities in patients' prospects for transplants.
Dozens of organ banks, many originally formed by university hospitals to feed their kidney transplant centers, were the foundation for the current system. With federal approval, the banks divided the country into a patchwork of territories, with some extending across vast areas and others carving up tiny states. Patients within each territory were to have the first option on any organs collected there, with the remainder to be offered outside.
But city-dwellers have higher rates of drug addiction and disease and need more organs, but this means urban donors are scarce. Transplant centers in less populated venues often choose who joins their waiting lists more carefully. Other factors are also at play, such as car crash rates and organ-recovery expertise. And while kidney patients can survive for years with dialysis, drugs, and other devices, liver patients generally face a steady decline toward death in the absence of a transplant.
Territories surrounding New York, Los Angeles, and San Francisco together account for 30 percent of the more than 17,000 people waiting for liver transplants nationwide.
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