Geographic disparities in organ transplantation represent one of the most persistent inequities in modern medicine, potentially determining who lives or dies based simply on where patients receive care. Despite policy reforms designed to create more equitable distribution, new evidence suggests that transplant center location continues to significantly influence a patient's access to life-saving lung transplants.
This comprehensive analysis examined 3,917 adult lung transplant candidates across 61 centers from September 2023 through December 2024, focusing on distance-adjusted donor availability under the Composite Allocation Score system. The research employed sophisticated spatial regression modeling to evaluate geographic variation and used counterfactual analyses to simulate the effects of recent policy amendments that increased the weight of geographic proximity in donor allocation decisions.
The findings reveal troubling persistent geographic inequities despite the transition from rigid distance thresholds to the supposedly more flexible continuous distribution framework. This challenges the fundamental assumption that recent policy reforms have successfully addressed geographic disparities in organ allocation. The study's use of distance-adjusted donor availability as a metric—accounting for both biological compatibility and geographic efficiency—provides a more nuanced understanding of true transplant access than simple waiting times or transplant volumes.
For patients with end-stage lung disease, these results underscore the critical importance of transplant center selection, though such choices are often limited by insurance networks, financial resources, and medical stability for travel. The research suggests that despite technological advances and policy refinements, the accidents of geography continue to create unacceptable disparities in transplant access, highlighting the need for more fundamental structural reforms in organ allocation policy.