Practical implications: Explicitly accounting for the local variation in the organ supply and candidate demand can lead to further improvements in organ distribution policy-which will ultimately result in robust policies promoting greater equity for transplant candidates across the U.S. Rather, a customized “heterogeneous” approach that accounts for both the organ supply and candidate demand locations and adjusts the radii of the donor circles more effectively addresses geographic equity by equalizing the s/d ratios across all transplant centers to closely match the national s/d ratio. Prior organ distribution policies have resulted in great disparities in the organ supply to candidate demand (s/d) ratios across transplant centers, causing large differences in waiting times and mortality rates across them.Ĭore insight: A fixed radius donor circle policy, where transplant centers within a fixed distance from a donor hospital get priority access to livers, does not reduce the variation in the s/d ratio across transplant centers. Problem specification: This paper focuses on improving geographic equity in access to liver transplant in the United States (U.S.). Our model matches the supply and demand in a more equitable fashion than existing policies and has a significant potential to improve the liver transplantation landscape. We found that with the fixed radius policy of 500 nautical miles (NM), the s/d ratio ranges from 0.37 to 0.84 at transplant centers, while with the heterogeneous circle policy capped at a maximum radius of 500 NM, the s/d ratio ranges from 0.55 to 0.60, closely matching the national s/d ratio average of 0.5983. Compared to the current policy, which has fixed radius circles around donation locations, the heterogeneous donor circle policy greatly improves both the worst s/d ratio and the range between the maximum and minimum s/d ratios. Our policy can be viewed as a heterogeneous donor circle policy, where the integer program optimizes the radius of the circle around each donation location. This allows us to reformulate our model as a set-partitioning problem. We design circular donation regions that are able to address the issues raised in legal challenges to earlier organ distribution frameworks. To design a fairer system, we develop a nonlinear integer programming model that allocates the organ supply in order to maximize the minimum s/d ratios across all transplant centers. is fundamentally an outcome of variation in the organ supply to patient demand (s/d) ratios across the country (which cannot be treated as a single unit due to its size). The United States (U.S.) Department of Health and Human Services is interested in increasing geographical equity in access to liver transplant.

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