![]() We can – if we choose to – have a unified heartbeat despite our differences.”īy Dr. Our physical parts are even interchangeable. My heart might be Hispanic, Black, Native American, Indian or Caucasian… My experience as a heart transplant recipient brought home an essential truth to me: We are ALL part of one another. There should not be any disparities in receiving it.Īs a recent heart transplant said: “I know nothing about my new heart other than it has saved my life. Given all the ongoing changes in policies, I believe there is good momentum to get there. Further studies are needed to establish causal mechanisms leading to these disparities and evaluate tailored interventions to resolve them. Black and female patients have been systemically disadvantaged when accessing the service. However, sex and race have been described in the literature as social determinants affecting transplantation inequities and have received the most attention from researchers, policy makers and the public. 3, 2024.Įach organ is different and we should add/remove variables in the model for a specific organ based on rigorous scientific evidence. In January 2023, the OPTN also published a new policy mandating transplant programs submit complete eGFR waiting time modifications for all affected candidates and inform all registered kidney candidates by Jan. In addition, the use of race adjustments in the calculation of eGFR had the potential to exacerbate existing disparities and negatively impact patient outcomes. Overestimated eGFR values resulting from race adjustments had the potential to delay referral for kidney transplantation and the initiation of qualifying waiting time. The inclusion of the race variable in eGFR calculations had shown to increase eGFR values by as much as 16% for Black individuals. This policy called for race to be removed from the formula to calculate Estimated Glomerular Filtration Rate (eGFR) for newly registered kidney transplant candidates. Last July, the OPTN issued a new policy update to resolve racial disparities in kidney transplantation. Fortunately, the OPTN updates its prediction model using the most recent data at least every 5 years. While the new MELD has improved, there are reasons to be skeptical about whether it should be the ultimate model. In addition, females had a 14% lower transplant rate than males with similar MELD score and other clinical factors. Using the previous MELD score, women were 19% more likely to die on the waiting list as compared to men. The new MELD score aims to resolve the disparities in transplant rate and waitlist mortality for female patients as described on American Journal of Transplantation (AJT) more than 10 years ago. The most notable of these changes was to add sex as a variable used in the model. ![]() ![]() This update improved the model for end-stage liver disease (MELD) scoring system by incorporating additional variables (albumin and sex), updating coefficients for existing variables, introducing interaction terms and lowering the maximum creatinine value to 3.0 mg/dL from 4.0. The Organ Procurement and Transplantation Network (OPTN) released its latest policy updates on July 13, 2023, that aimed to improve equity in liver allocation. ![]()
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