{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T12:51:48Z","timestamp":1790772708257,"version":"4.1.0"},"reference-count":35,"publisher":"American Medical Association (AMA)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"published-print":{"date-parts":[[2024,8,1]]},"abstract":"<jats:sec id=\"ab-soi240027-4\"><jats:title>Importance<\/jats:title><jats:p>A new liver allocation policy was implemented by United Network for Organ Sharing (UNOS) in February 2020 with the stated intent of improving access to liver transplant (LT). There are growing concerns nationally regarding the implications this new system may have on LT costs, as well as access to a chance for LT, which have not been captured at a multicenter level.<\/jats:p><\/jats:sec><jats:sec id=\"ab-soi240027-5\"><jats:title>Objective<\/jats:title><jats:p>To characterize LT volume and cost changes across the US and within specific center groups and demographics after the policy implementation.<\/jats:p><\/jats:sec><jats:sec id=\"ab-soi240027-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This cross-sectional study collected and reviewed LT volume from multiple centers across the US and cost data with attention to 8 specific center demographics. Two separate 12-month eras were compared, before and after the new UNOS allocation policy: March 4, 2019, to March 4, 2020, and March 5, 2020, to March 5, 2021. Data analysis was performed from May to December 2022.<\/jats:p><\/jats:sec><jats:sec id=\"ab-soi240027-7\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>Center volume, changes in cost.<\/jats:p><\/jats:sec><jats:sec id=\"ab-soi240027-8\"><jats:title>Results<\/jats:title><jats:p>A total of 22 of 68 centers responded comparing 1948 LTs before the policy change and 1837 LTs postpolicy, resulting in a 6% volume decrease. Transplants using local donations after brain death decreased 54% (<jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001) while imported donations after brain death increased 133% (<jats:italic>P<\/jats:italic>\u2009=\u2009.003). Imported fly-outs and dry runs increased 163% (median, 19; range, 1-75, vs 50, range, 2-91; <jats:italic>P<\/jats:italic>\u2009=\u2009.009) and 33% (median, 3; range, 0-16, vs 7, range, 0-24; <jats:italic>P<\/jats:italic>\u2009=\u2009.02). Overall hospital costs increased 10.9% to a total of $46\u202f360\u202f176 (<jats:italic>P<\/jats:italic>\u2009=\u2009.94) for participating centers. There was a 77% fly-out cost increase postpolicy ($10\u202f600\u202f234; <jats:italic>P<\/jats:italic>\u2009=\u2009.03). On subanalysis, centers with decreased LT volume postpolicy observed higher overall hospital costs ($41\u202f720\u202f365; <jats:italic>P<\/jats:italic>\u2009=\u2009.048), and specifically, a 122% cost increase for liver imports ($6\u202f508\u202f480; <jats:italic>P<\/jats:italic>\u2009=\u2009.002). Transplant centers from low-income states showed a significant increase in hospital (12%) and import (94%) costs. Centers serving populations with larger proportions of racial and ethnic minority candidates and specifically Black candidates significantly increased costs by more than 90% for imported livers, fly-outs, and dry runs despite lower LT volume. Similarly, costs increased significantly (&amp;amp;gt;100%) for fly-outs and dry runs in centers from worse-performing health systems.<\/jats:p><\/jats:sec><jats:sec id=\"ab-soi240027-9\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>Based on this large multicenter effort and contrary to current assumptions, the new liver distribution system appears to place a disproportionate burden on populations of the current LT community who already experience disparities in health care. The continuous allocation policies being promoted by UNOS could make the situation even worse.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamasurg.2024.1208","type":"journal-article","created":{"date-parts":[[2024,5,29]],"date-time":"2024-05-29T15:01:09Z","timestamp":1716994869000},"page":"939","source":"Crossref","is-referenced-by-count":22,"title":["Liver Transplant Costs and Activity After United Network for Organ Sharing Allocation Policy Changes"],"prefix":"10.1001","volume":"159","author":[{"given":"Ola","family":"Ahmed","sequence":"first","affiliation":[{"name":"Division of Abdominal Organ Transplantation, Department of Surgery, Washington University School of Medicine, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Bernadette Majella","family":"Doyle","sequence":"additional","affiliation":[{"name":"Division of Abdominal Organ Transplantation, Department of Surgery, Washington University School of Medicine, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marwan S.","family":"Abouljoud","sequence":"additional","affiliation":[{"name":"Transplant Institute and Hepatobiliary Surgery, Henry Ford Hospital Detroit, Detroit, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diane","family":"Alonso","sequence":"additional","affiliation":[{"name":"Intermountain Medical Center, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramesh","family":"Batra","sequence":"additional","affiliation":[{"name":"Yale New Haven Health Transplantation Center, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth L.","family":"Brayman","sequence":"additional","affiliation":[{"name":"Division of Transplant Surgery, University of Virginia Health System, Charlottesville"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diane","family":"Brockmeier","sequence":"additional","affiliation":[{"name":"Mid-America Transplant Services, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert M.","family":"Cannon","sequence":"additional","affiliation":[{"name":"Comprehensive Transplant Institute, University of Alabama, Tuscaloosa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth","family":"Chavin","sequence":"additional","affiliation":[{"name":"Temple University Health System, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron M.","family":"Delman","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Cincinnati Medical Center, Cincinnati, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Derek A.","family":"DuBay","sequence":"additional","affiliation":[{"name":"Department of Transplant Surgery, Medical University of South Carolina, Charleston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Finn","sequence":"additional","affiliation":[{"name":"Midwest Transplant Network, Westwood, Kansas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan A.","family":"Fridell","sequence":"additional","affiliation":[{"name":"Department of Abdominal Transplant Surgery, Indiana University Health Transplant Institute, Indianapolis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barry S.","family":"Friedman","sequence":"additional","affiliation":[{"name":"AdventHealth Transplant Institute, Orlando, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle M.","family":"Fritze","sequence":"additional","affiliation":[{"name":"Department of Transplant Surgery, University of Texas Health Science Center at San 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K.","family":"Kohli","sequence":"additional","affiliation":[{"name":"Department of Transplant and Hepatobiliary Surgery, Integris Baptist Medical Center, Oklahoma City, Oklahoma"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean C.","family":"Kumer","sequence":"additional","affiliation":[{"name":"Division of Transplantation and Hepatobiliary Surgery, University of Kansas Health System, Kansas City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan","family":"Langnas","sequence":"additional","affiliation":[{"name":"Division of Transplant Surgery, University of Nebraska Medical Center, Lincoln"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jayme E.","family":"Locke","sequence":"additional","affiliation":[{"name":"Comprehensive Transplant Institute, University of Alabama, Tuscaloosa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Maluf","sequence":"additional","affiliation":[{"name":"Division of Transplantation and Hepatobiliary Surgery, University of Maryland, Baltimore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raphael P. H.","family":"Meier","sequence":"additional","affiliation":[{"name":"Division of Transplantation and Hepatobiliary Surgery, University of Maryland, Baltimore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandro","family":"Mejia","sequence":"additional","affiliation":[{"name":"Methodist Medical Center, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaheed","family":"Merani","sequence":"additional","affiliation":[{"name":"Division of Transplant Surgery, University of Nebraska Medical Center, Lincoln"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David C.","family":"Mulligan","sequence":"additional","affiliation":[{"name":"Yale New Haven Health Transplantation Center, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bobby","family":"Nibuhanupudy","sequence":"additional","affiliation":[{"name":"AdventHealth Transplant Institute, Orlando, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madhukar S.","family":"Patel","sequence":"additional","affiliation":[{"name":"Division of Surgical Transplantation, University of Texas Southwestern Medical Center\/William P. Clements Jr. University Hospital, Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shawn J.","family":"Pelletier","sequence":"additional","affiliation":[{"name":"Division of Transplant Surgery, University of Virginia Health System, Charlottesville"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shimul A.","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Cincinnati Medical Center, Cincinnati, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parsia A.","family":"Vagefi","sequence":"additional","affiliation":[{"name":"Division of Surgical Transplantation, University of Texas Southwestern Medical Center\/William P. Clements Jr. University Hospital, Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodrigo","family":"Vianna","sequence":"additional","affiliation":[{"name":"University of Miami Transplant Institute, Miami, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gazi B.","family":"Zibari","sequence":"additional","affiliation":[{"name":"Willis Knighton Advanced Surgery Center, Willis-Knighton Health System, Shreveport, Louisiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teresa J.","family":"Shafer","sequence":"additional","affiliation":[{"name":"Teresa Shafer Consulting, Fort Worth, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan L.","family":"Orloff","sequence":"additional","affiliation":[{"name":"Division of Abdominal Organ Transplantation\/Hepatobiliary Surgery, Oregon Health & Science University, 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