ABSTRACT
Purpose: Despite several policy reforms over the years, disparities in the access to solid organ transplantation continues to exist remains a significant barrier to liver transplant. The MELD Allocation system and subsequently the Share-35 policy (adopted June 2013) were implemented to address the inequitable access to liver transplantation (LT). The implication of these changes on adult and pediatric LT among ethnic groups is uncertain. Therefore the aim of this study, is to explore the factors associated with access to LT across ethnic groups of all age groups. Method(s): The study period (2014 -2019) included the period after Share-35 policy (June 2013) implementation and prior to implantation of Acuity Circle and COVID pandemic (Feb/March 2020). Using the UNOS database, we identified all candidates (Pediatrics and Adults), who received liver Transplant during the study period. Data extracted included type of transplant, liver diagnosis, age, MELD/PELD score, gender and race/ethnicity. Chi square test and anova were used for comparative analysis. Result(s): During the study period, 46,926 candidates received liver transplant of which 96% were Adults, living donor LT (5%) and ethnic distribution (White 69%, Hispanic 15%, Black 9%, Asian 4% and others 3%). In contrast to the Adult recipients in which there is a gender variation with male predominance (65%), among pediatric group there was similar distribution (Male 51% and Female 49%). There was significant ethnic variation in type of insurance payor (Figure 1) and proportion of LT (Figure 2) across age groups. Among pediatric recipients, no significant difference in LT trends across ethnic groups. In contrary, among the adult recipients, though there was no change among White (71% in 2014 and 71% in 2019) and Asian (4% in 2014 and 4% in 2019), there was slight increase among Hispanic ( 13 % in 2014 and 16% in 2019) and a steady decline among Blacks ( 10% in 2014 and 7.3% in 2019). Conclusion(s): Ethnic Variation in Access to Liver Transplantation exists in both Adult and Pediatric Candidates. Future studies to explore the observed difference in Insurance payors, gender gaps among ethnic groups will provide useful insights to the non-medical factors contributing to inequitable LT access irrespective of age. Identification and understanding the key social determinants that impact LT access will be key in developing strategies to reduce and eliminate these barriers across age groups.
ABSTRACT
Purpose: Health disparities in the United States (U.S.) have become more evident during the pandemic with disproportionate death rates in Blacks and Hispanics (with and without COVID-19). The purpose of this study was to examine U.S. data for rates of change in deceased organ donation and transplantation during a global pandemic. Method(s): We conducted a retrospective analysis of U. S. aggregated data from the Organ Procurement and Transplantation Network (OPTN) from January 2019 to December 2021. The data collected included organ donation, transplantation, and UNOS regions. We calculated the annual percentage change for Whites, Blacks, and Hispanics during the pandemic (2020-2021). Result(s): The overall annual rate of change in deceased donor organ donation increased by 6% in 2020 and 10% in 2021. However, ethnic minorities experienced a combined 14% increase in 2020 deceased organ donation (10% Black and 4% Hispanic), but a combined 1% decrease in 2021 (-3% Blacks and 2% Hispanics). The overall annual rate of change in deceased donor organ transplantation increased by 3% in 2020 and 5% in 2021. However, Black and Hispanic recipients experienced a collective 6% increase in deceased organ transplantation in 2020 (5% Blacks and 1% Hispanics) and a summative 17% increase in 2021 (8% Blacks and 11% Hispanics). Regional variation was also observed across ethnic groups. Conclusion(s): Overarching cultural disparities affect organ donation and transplantation;thus, it is imperative to examine the relative annual changes by ethnicity alongside overall changes. COVID and non-COVID excessive death rates in people of color during the pandemic played a role in potential candidates for organ donation and transplantation. In 2020, when excessive minority deaths were attributed to COVID-19 by the CDC, the rate of minority deceased organ donation increased by 14% (10% Blacks and 4% Hispanics). During this same timeframe, the rate of transplants increased in Black (5%) and Hispanic (1%) recipients. Since the implementation of widespread vaccination distribution, community education for vaccination hesitancy, and access to more aggressive treatment and testing options, these trends in minority organ donation have not persisted. Exactly how this translates into long-term disparities in end-organ failure, organ donation, and transplantation has yet to be determined. (Figure Presented).
ABSTRACT
Purpose: Patterns of racial disparities have been identified throughout the history of American medicine. In December 2019, COVID-19 was first detected and has had a significant impact at a global level. Evidence suggests that racial and ethnic minorities bear a disproportionate COVID-19 burden. Since the onset of the pandemic, there has been a decrease in the number of solid organ transplants (SOT) performed. The main objective of this study was to evaluate the impact of COVID-19 on the field of solid organ transplantation. Methods: We conducted a retrospective cohort study on consecutive solid organ transplants performed in the U.S. before and after the onset of the COVID-19 pandemic from January 2019 through June 2020. We utilized national data from the United Network for Organ Sharing (UNOS) and the Organ Procurement Transplantation Network (OPTN). Deidentified data were analyzed on patients who underwent either kidney, liver, heart, lung, or combined heart and lung transplants. The number of transplants based on UNOS regions, age, gender, and ethnicity were analyzed. Results: Our data demonstrated significant declines in liver transplants among ethnic minorities compared to the white population (p<0.001). In patients under 18, liver transplants were significantly reduced (p<0.001), while liver and heart/ lung transplants were most impacted in the 18-49 age group (p<0.001). When comparing the number of SOTs by UNOS region, a significant decrease in kidney transplants was observed across regions 1, 7, 8, 9, and 10 (p<0.001). Additionally, liver transplants were markedly decreased in region 5 (p<0.001), as well as regions 4 and 7 (p<0.05). Finally, regions 2 and 9 demonstrated a statistically significant drop in heart/lung transplants (p<0.05). Conclusions: Amid the pandemic, organ transplantation has been deemed a medical emergency and yet there has been a significant decline in the number of transplants across UNOS regions, age groups, genders, organ types, and ethnicities. Despite the unique challenges brought about by COVID-19, physicians have managed to continue to carry out lifesaving transplant procedures.
ABSTRACT
Background: In Feb 2020, UNOS adopted the Acuity Circle Policy for Liver Allocation and in March 2020, SARS COV-2 Infection was declared Pandemic and National Emergency in USA Nationwide, COVID disproportionately impacted ethnic minorities with a significant variation in geographic distribution. Historically, ethnic and regional variation exists across USA in access to Liver Transplantation (LT) Therefore the Aim of this study is to determine the impact of COVID Pandemic on access to LT Methods: Using the UNOS database, we identified all adult patients (> 18 years) who received Solid organ transplant (SOT: liver, kidney, heart, lung) between Feb 2020 and June 2020 Data extracted included recipient demographics, MELD, UNOS regions Chi-square tests and ANOVA tests were used for comparative analysis Results: During the study period, 14,741 received SOT There were 3420 recipients (pre-COVID;Feb 2020) and 11,321 recipients (COVID: March to June 2020) The Peak COVID Period was in April 2020 (see Figure 1) Overall, at the Peak period, there was a 38% reduction in SOT The greatest decline was kidney (44 7%) and least liver (23 4%) Among LT recipients, significant decline was only observed in three geographic locations: region 1 (53%), region 9 (40%) and Region 6 (31%) but no significant ethnic variation was observed (see Figure 2) Conclusion: The observed regional variation in LT correlated with the COVID 'hotspots' Despite the reports of disproportionate impact of COVID on ethnic minorities in US population, our study showed no impact among LT recipients Future and long-term studies are needed to explore and better understand the association (dynamics) between COVID and Social determinants of access to LT and LT Outcomes(Figure Presented).