Deceased donor organs and nautical miles

UNOS has recently announced a new distribution system for deceased kidney and pancreas offers: instead of being offered first to waiting-list patients at transplant centers in the same one of the 58 Donor Service Areas and then one of the 11 OPTN geographical regions as the donor hospital, they will now be offered first to patients on the waiting lists of transplant centers within 250 nautical miles of the donor hospital.

(Why nautical miles? I don't know, but you can read the various proposals that were considered before deciding on 250 of them at this earlier post: Sunday, May 12, 2019  UNOS proposal for public comment: Eliminate the use of DSAs and regions from kidney and pancreas distribution.)

Here is the new (Dec 5, 2019) announcement: 

New policy adopted to improve kidney, pancreas distribution

"Under the newly approved system, expected to be implemented in 2020, kidney and pancreas offers (except for rare, very well-matched donor and recipient combinations nationwide) will be offered first to candidates listed at transplant hospitals within 250 nautical miles of the donor hospital. Offers not accepted for any of these candidates will then be made for candidates beyond the 250 nautical mile distance.

"Candidates also will receive proximity points based on the distance between their transplant program and the donor hospital. Proximity points are intended to improve the efficiency of organ placement by adding priority for candidates closer to the donor hospital. Candidates within the initial 250 nautical mile radius will receive a maximum of two proximity points, while those outside the initial circle will receive a maximum of four proximity points. The point assignment will be highest for those closest to the donor hospital and will decrease as the distance increases.

"Differences from current system and predicted benefits

"The new system will replace a three-tiered approach used since the beginning of national organ allocation policies in the mid-1980s. Currently, most kidney and pancreas offers go first to candidates listed at hospitals within the same donation service area (DSA) where the donor hospital is located. There are 58 DSAs reflecting the assigned service area of organ procurement organizations (OPOs). These DSAs are fixed, often irregular geographic boundaries, and were not set for the express purpose of optimizing organ allocation. In some instances, portions of the same DSA are not contiguous, meaning that some “local” donor matches may travel through service areas belonging to other OPOs.

"Organ offers not accepted at the DSA level currently are made to candidates at hospitals within the same OPTN region as the donor hospital. Finally, offers not accepted at the DSA or regional level are made to candidates listed at transplant programs anywhere else in the United States.

************

One impetus for the move away from geographic allocation within strict borders is because that system was challenged in the courts, see

Friday, December 29, 2017  The courts take an interest in organ allocation rules

Under the new system, arbitrary borders will no longer have such a big effect on access to transplantation. (Except that is for international borders, which are often still insuperable barriers...)