The organ matching and offer process primarily looks at potential recipient and donor data to determine physical and immunogenic compatibility. However, additional factors are also at play in the process of saying yes to an organ. For example, individual transplant centers, hospitals, and even surgeons have varying risk tolerances for accepting organs. Some centers have a policy of not accepting Hepatitis C positive (HCV-positive) donor organs. Other times, individual surgeons may not accept HCV-positive donor organs.

The matching and offer process not only uses patient and donor data to determine physical and immunogenic compatibility, but also assesses recipient priority based on medical urgency as well as utility, which is sometimes measured as the number of years gained for the patient through the transplant. While a very elderly patient may have high medical urgency, they may be less able to utilize the kidney of a young patient which may last 20 plus years.

It is hard enough for a potential transplant recipient to get on the waitlist, let alone maintain and manage their waitlist status. The process of getting tests updated can be challenging for some patient populations, particularly those with language barriers and lack of access to transportation.

When patients are notified that their testing is out-of-date– often via mail– they may call the transplant center looking for further guidance. However, many centers are understaffed and may not be able to provide adequate support in a timely manner.

Transplant professionals interviewed by Afflo consistently identified a data collection problem prior to patient waitlisting. Pre-waitlisting data is seen as a "black box", even though access to the waitlist is a major equity issue. Waitlist access clearly shows the impact Social Determinants of Health (SDOH) have on transplant patient outcomes.

This post is Part One in Afflo's Transplant Equity Series.

Organ donation and transplantation community members and advocates know that transplant has an equity problem. Balancing the utility of a donated organ with equity has been a longstanding, core tension. Utility is maximized by prioritizing patients who will get the most benefit out of the organ (based on a combination of their disease severity and their ability to sustain the graft). Equity ensures all patients, regardless of health status or sociodemographic factors (age, race, income, access to insurance) have access to organs transplants. Recently, scrutiny on equity has grown based on the National Academy for Sciences Engineering and Medicine’s report, Realizing the Promise of Equity in the Organ Transplantation System.