Not making this up. Actual problem of rationing kidneys by region (article here), causing large differences in access across the nation.
During his most recent hospital stay, Reginald Baker received bad news from his doctor. Over many years, his kidneys had gradually lost their ability to function, and now he would need a transplant. Reginald’s doctor said he would be added to a transplant list, but the waiting period for a kidney could be years. Reginald would be joining the approximately 80,000 people who are awaiting a kidney, while the annual number of transplants peaks at only about 17,000.
Reginald was especially surprised to learn that one of the factors adding the most time to his wait for a new kidney wasn’t his blood type or the severity of his disease but, rather, his geographical location. The closest transplant center to where Reginald lived served the large metropolitan region of the San Francisco Bay Area. His doctor explained that the area faced a particularly severe organ shortage due to the number of residents in need of transplants. Smaller towns in the Midwest, for example, have less competition for organs and are better supplied with kidneys for transplantation.
Reginald didn’t have the resources or the health to relocate himself and his family or to travel far from his home and his hospital to try to improve his chances of getting a kidney. He would just have to wait and hope.
ARRA May Help Improve Organ Allocation
Dr. Krista Lentine, associate professor of medicine at Saint Louis University, is addressing the plight of the thousands of Americans awaiting life-saving organs, particularly kidney and liver transplantations. With support from NIH and the American Recovery and Reinvestment Act (ARRA), Lentine and her team are highlighting geographical disparities and working to develop improved systems to ensure fairness in organ allocation.
Lentine’s motivation stems from her observation that patients with similar illness severity experience different waiting times due to imbalances in geographical supply and demand. For example, the average waiting time for a blood group O kidney varies from 2.8 years in a well-supplied Midwest region to more than 6 years in a West Coast region.
The United States currently is divided into 11 geographic organ-sharing regions that direct organ distribution. Operating within this geographical system are nationally agreed-upon rules that define priority among transplant candidates. For liver transplants, priority is determined based on illness severity using a scoring system that predicts the patient’s risk of death without a transplant. For those awaiting kidney transplants, however, priority is mostly determined by how long the patients have been waiting.
“These regions were not developed by any scientific method, but the intent was to divide the country in a way that would place organs quickly and encourage local donation,” said Lentine. “However, the current regions are heterogeneous in size and population, leading to mismatching in available organs with waiting candidates.”
(Nod to Michael Hartwell)