Policy Change in Allocating Livers for Transplantation Increases Travel Distance for Organ Recovery

liver transplant, surgery
Investigators assessed whether a recently implemented policy was associated with changes in travel distance for organ recovery and number of organ imports and exports.

The median travel distance to recover a liver for transplantation more than doubled in the month after the Organ Procurement and Transplantation Network (OPTN) and United Network for Organ Sharing (UNOS) implemented a new policy for allocating donor livers for transplant, researchers reported in JAMA Surgery.

The new policy was implemented on February 4, 2020, and involved changing from a donor service area–based allocation model to one focused on radially oriented zones (acuity circles) around potential donors. The goals were to improve access to transplants for candidates who had the greatest urgency, increase the number of pediatric transplants, and reduce waitlist mortality.

The study authors used data from UNOS to assess whether implementation of the policy was associated with immediate changes in the distance traveled for organ recovery or the proportion of organ imports or exports by regions. All accepted liver offers from deceased donors were identified from January 3, 2020, to March 3, 2020, before changes in practice occurred due to the coronavirus disease 2019 (COVID-19) pandemic.

The researchers found that implementation of the acuity circle policy was associated with a 105% relative increase in travel by recovery teams (130.4 to 267.2 km) throughout the United States. Some of the 11 OPTN regions—such as the one including Colorado, Iowa, Kansas, Missouri, Nebraska, and Wyoming—had larger relative increases in travel distance (381%; 77.2 to 370.1 km), and others, such as the region that included Texas and Oklahoma, had little change (−0.1%; 251.1 to 249.4 km).

The policy change also affected the number of organs imported and exported according to the OPTN regions. After the change, transplant centers imported 309.8% more livers (61 before and 250 after implementation) from outside their region and exported 344% more livers (54 before and 240 after implementation) recovered to another region. The number of transplants (797 vs 779 [absolute difference, −2.2%]) and available donors (790 vs 769 [absolute difference, −2.7%]) was qualitatively stable before and after the change, noted the investigators.

The study is limited by its short time frame. The researchers were unable to determine how the changes may affect known variation in the median model for end-stage liver disease at transplant in the long term.

“Any change in liver allocation reminds the transplant community that cooperation between transplant centers, organ procurement organizations, and policy makers is key,” the study authors commented. “It can foster innovative changes in organ recovery practices, such as local recovery, that may be necessary should centers continue to experience increasing travel demands under the new policy.”


Sheetz KH, Waits SA. Outcome of a change in allocation of livers for transplant in the United States. JAMA Surg. Published online March 17, 2021. doi: 10.1001/jamasurg.2021.0137