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Organ Procurement and Transplantation: Assessing Current Policies and the Potential Impact of the DHHS Final Rule
is measured in months. For status 3 (or 4) patients, who have the least urgent need for transplantation, waiting times may reach years. Historically, more than 50 percent of the patients awaiting liver transplants at any given time have been classified as status 3 (see Table 5-1 and Appendix B, Tables B-1, B-4, B-6, and B-9).
In issuing the Final Rule, the Department of Health and Human Services (1998b) used regional differences in median waiting times for all patients combined as a basis for claiming that inequities exist in the allocation of organs to transplant patients. Panel 1 of Figure 5-1 illustrates the differences in median waiting times among the 11 UNOS regions, grouped by quartiles, for all liver transplant candidates registered between January 20, 1998, and January 19, 1999. Although dividing the waiting time distribution into quartiles oversimplifies these data, this method is similar to that used in previous analyses by DHHS. On this basis, median waiting times are shortest in the South and upper Midwest and longest in New England and the Northwest (including Alaska). However, given that the majority of transplant patients are classified as status 3, these differences principally reflect the differences in waiting time of status 3 patients (see panel 5), who have the least serious need and, therefore, the longest wait for transplantation. Panels 2 and 3 show that statuses 1 and 2A patients contribute little or no regional variability in overall waiting times. Panels 4 and 5 show that variability in overall waiting time is produced almost entirely by statuses 2B and 3 patients.
TABLE 5-1 Characteristics of Liver Transplant Patients by Status, 1995-1999
Status 1 (all patients)
Status 2 (all patients)
Status 3 (all patients)
Total patients, 1995-1999
Percentage receiving a transplant
Percentage dying prior to transplantation
Percentage of posttransplant mortality
Percentage with A or AB blood type
Percentage African American
Mean waiting time
NB: The "Totals" columns involve the number of unique listings and therefore does not involve the sum of the other three columns which involve patients within status levels (i.e., a given patient may occupy one to three status levels for a particular listing).