Moving past “think local, act global”: A perspective on geographic disparity

Raymond J. Lynch, Joseph F. Magliocca, Jonathan C. Hundley, Seth J. Karp

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


The transplant community has debated the necessity and merits of broader organ distribution for several years, but the debate has been fundamentally shaped by inaccurate assessments of donor supply and demand. The possible legal requirements of distribution must be balanced with (a) the moral and statutory imperatives to reduce inequities resulting from socioeconomic disparity, and (b) the shortcomings of MELD in predicting mortality risk in rural areas. In this viewpoint, we use the example of liver transplantation to discuss the drivers of geographic disparity as a direct consequence of donation rates, local organ use, wealth, and poverty. Seen in this light, strategies seeking to equalize MELD at transplant across the United States risk severely exacerbating existing inequalities in access to health care.

Original languageEnglish (US)
Pages (from-to)1907-1911
Number of pages5
JournalAmerican Journal of Transplantation
Issue number7
StatePublished - Jul 2019

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)


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