Fair Share of Organs for Transplantation
The United Network for Organ Sharing (UNOS) is the main body in the U.S. responsible for the allocation of organs for transplantation. UNOS is a private non-profit organization under contract with the federal government to manage the national waiting list, maintain database and assure the fair allocation of organs.
To make sure the system matches donor and recipient in a fair way, UNOS is using technology with the help of statistical model to account for distance and other key factors such as age, urgency, etc, to optimize allocation.
Previously UNOS used a system that depends solely on geographical factor based on the Donation Service Area (DSA). Such geographical system might lead to depriving people that need organ the most while transplanting less urgent cases in their early organ failure stage.
The previous geographical-based system, the DSA, also creates health inequality for the following reason:
- The Donation Service Area are not equal in the number of the transplant system
- The Donation Service Area are not equal in organ availability
- The demand for organ (patient: organ ratio) varies from DSA to DSA
Fairness in healthcare is a critical pillar for each healthcare system. Fairness is not only to give equal service to everybody but to prioritize those who need more services or need them the most. The same thing happens when a patient visits an emergency room; even though the patient waited longer, a sicker patient might take a priority to be seen before everybody else.
In 2015, over 15,000 thousand American were waiting their turn to have a liver transplantation. Alas, only about 6,500 livers were donated. Consequently, many patients die before their turns come. Organs shortage can't be managed merely by increasing donors and transplant centers. Transplantation should be the last resource; public health awareness and prevention should be a top healthcare priority to improve the quality of life and save resources of transplantations more to patients with the none-preventable cause of organ failure.
When prevention, primary care, patients' behaviors, and chronic disease management do not work within a healthcare system properly, then we expect to see many transplantations due to preventable diseases. In such cases, transplantation is a failure of healthcare.