The Impact of Redistricting Proposals on Health Care Expenditures for Liver Transplant Candidates and Recipients

S. E. Gentry, E. K.H. Chow, N. Dzebisashvili, M. A. Schnitzler, K. L. Lentine, C. E. Wickliffe, E. Shteyn, J. Pyke, A. Israni, B. Kasiske, D. L. Segev, David A. Axelrod

Research output: Contribution to journalArticlepeer-review

27 Scopus citations


Redistricting, which means sharing organs in novel districts developed through mathematical optimization, has been proposed to reduce pervasive geographic disparities in access to liver transplantation. The economic impact of redistricting was evaluated with two distinct data sources, Medicare claims and the University HealthSystem Consortium (UHC). We estimated total Medicare payments under (i) the current allocation system (Share 35), (ii) full regional sharing, (iii) an eight-district plan, and (iv) a four-district plan for a simulated population of patients listed for liver transplant over 5 years, using the liver simulated allocation model. The model predicted 5-year transplant volumes (Share 35, 29 267; regional sharing, 29 005; eight districts, 29 034; four districts, 28 265) and a reduction in overall mortality, including listed and posttransplant patients, of up to 676 lives. Compared with current allocation, the eight-district plan was estimated to reduce payments for pretransplant care ($1638 million to $1506 million, p < 0.001), transplant episode ($5607 million to $5569 million, p < 0.03) and posttransplant care ($479 million to $488 million, p < 0.001). The eight-district plan was estimated to increase per-patient transportation costs for organs ($8988 to $11 874 per patient, p < 0.001) and UHC estimated hospital costs ($4699 per case). In summary, redistricting appears to be potentially cost saving for the health care system but will increase the cost of performing liver transplants for some transplant centers.

Original languageEnglish (US)
Pages (from-to)583-593
Number of pages11
JournalAmerican Journal of Transplantation
Issue number2
StatePublished - Feb 1 2016

Bibliographical note

Funding Information:
The study was approved by the Dartmouth College Committee for the Protection of Human Subjects, the data oversight committee of the Organ Procurement and Transplantation Network (OPTN) and the Health Resources and Services Administration. This work was supported by a contract from the U.S. Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation (HHSH250201000018C). The work was also supported by an American Recovery and Reinvestment Act grant from the National Institute of Diabetes and Digestive and Kidney Diseases (RC1 1RC1DK086450-01). The data reported were supplied by the Minneapolis Medical Research Foundation, as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The SRTR data system includes data on all donors, waitlisted candidates and transplant recipients in the United States, submitted by the members of OPTN.

Publisher Copyright:
Copyright © 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.


  • Sharing (UNOS)
  • United Network for Organ
  • business
  • economics
  • ethics and public policy
  • health services and outcomes research
  • hepatology
  • liver disease
  • liver transplantation
  • management
  • organ allocation
  • organ procurement and allocation


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