Disparities in Liver Transplantation Resulting From Variations in Regional Donor Supply and Multiple Listing Practices.

Over the past 15 years, the Organ Procurement and Transplantation Network has implemented several policy changes in an attempt to create an equitable liver allocation and distribution system. Despite these efforts, geographic differences in donor organ availability and demand among the 11 United Network for Organ Sharing (UNOS) Regions determine waitlist mortality. In 2013, there were 3075 candidates who died awaiting liver transplantation, with UNOS Region 5 (Arizona, California, Nevada, New Mexico, and Utah) accounting for the highest number of annual deaths. To avoid waitlist mortality, candidates in UNOS Regions with longer waitlist-time-to-transplant have sought temporary residence and multiple listings in UNOS Regions with relatively shorter waitlist times. These candidates with multiple listings were awarded with favorable outcomes including a shorter wait time to liver transplantation. Expectedly, UNOS Region 5 had the highest number of candidates with multiple listings seeking liver transplantation in another UNOS Region. We aimed to study the disparities associated with listing practices of liver transplant candidates within UNOS Region 5.