Analyzing Geographic Disparity in U.S. Heart Allocation System Fatemeh Karami1, Mehdi Nayebpour2, Monica Gentili1, Naoru Koizumi2, Andrew L. Rivard3 1Industrial Engineering, University of Louisville, Louisville, KY 2Schar School of Policy and Government, George Mason University, Arlington, VA 3Department of Radiology, Cleveland Clinic, Abu Dhabi Background Method and Data In the United States, allocation of solid organs for transplantation is regulated and maintained by the United Network for Organ Sharing (UNOS). Fifty-eight Organ Procurement Organizations (OPO) are responsible for evaluation and procurement of deceased-donor organs. UNOS recently approved a major nationwide change to the allocation algorithm of hearts for adult candidates into categories of severity status allocation for the most urgent candidates. The Department of Health and Human Services Final Rule clearly states that ‘‘neither place of residence nor place of listing shall be a major determinant of access to a transplant” [1]. Based upon open access comments to the new algorithm; we hypothesize that the current allocation scheme contributes to geographic disparities. Aim: Compare geographic disparities in access to heart transplant based on current policy vs. a proposed new 6-tier model with broader geographical allocation. Method: We compared the transplant results of the two heart allocation models by simulating the policies using the Thoracic Simulated Allocation Model (TSAM). Data: 2009-2011 from UNOS data (age ≥ 18) containing 8434 adult patients needing only a heart transplant. Disparity metrics: We measured disparity at the OPO level and at the regional level computing the following metrics: Standard deviation Range Mean squared difference from the best rate (MSBR) Interquartile range (20th – 80th) Two OPOs had supply > greater than demand (green) One OPO, supply = demand (*) Three OPOs, had supply << demand (orange). * Results Geographic Disparities in Waiting Time to Transplantation Geographic Disparities in Pre-Transplant Mortality Rate Average of Total Waiting Time (days) Current Policy Proposed Policy Mean 177 171 STD 56 60 MSBR 151 172 Range 230 286 Interquartile range 176 174 The two policies have similar mean waiting times among OPOs. Geographic disparities exists in both policies in terms of waiting time. The proposed new policy increases geographic disparities in waiting time across OPOs. The proposed new policy decreases geographic disparities for waiting time for Status 1B and Status 2. The proposed policy increases geographic disparity in waiting time for Status 1A. The proposed new policy decreases mortality rate for patients on the waiting list. The proposed new policy decreases geographic disparity in pre-transplant mortality for status 1A patients across all OPOs. Pre-Transplant Mortality Rate Across OPOs Current Policy Proposed Policy Mean 0.07 0.03 STD 0.02 MSBR 0.045 Range 1 0.08 Interquartile range 0.05 Waiting Time to Transplantation Across OPOs for Proposed Policy 0 - 50 50- 100 100 - 150 150 - 200 200 - 300 300 - 350 Geographic Disparities in Transplant Rate Geographic Disparities in Distance Traveled by Organs The two policies have similear mean waiting time among OPOs. Geographic disparities exists in both policies in terms of transplant rate. The proposed new policy increases geographic disparity in transplant rates across OPOs. The proposed new policy increases geographic disparities of transplant rate for patients with different statuses. Average Transplant Rate Across OPOs Current Policy Proposed Policy Mean 0.56 0.59 STD 0.12 MSBR 0.22 0.25 Range 0.42 0.48 Interquartile range 0.23 Transplant Rate Across OPOs for New Policy The proposed 6 tier new policy increases the average distance that an organ will travel. The proposed new policy increases geographic disparities that an organ travels across OPO boundries Average Distance (Miles) Traveled by Organs in each Transplant Ctr Current Policy Proposed Policy Mean 193 219 STD 87 105 MSBR 212 236 Range 412 684 Interquartile range 138 136 0 - 0.25 0.25 - 0.45 0.45 - 0.65 0.65 - 0.85 0.85 - 1 Discussion and Conclusions References XXdd [1] DHHS. Organ Procurement and Transplantation Network; Final Rule (42 CFR Part 121). Federal Register 1998; 63(63): 16296–16338. Disclosure Statement: No use of off-label and/or investigational drugs/devices in this study/presentation. No relevant financial relationship exists for this study/presentation. With the proposed new 6-tier policy; transplant rates, waiting times and pre-transplant mortality rates all improve. With this 6-tier policy; the distance that organs will travel increases. With the proposed 6-tier policy; overall geographic disparities in transplant rate, waiting time and average distance traveled by organs increase.