RESEARCH
K08 GRANT SUPPORTS PROJECT TO IMPROVE EQUITY IN ORGAN ALLOCATION SYSTEM
Robert Cannon , MD , FACS , seeks to address a flaw in the organ allocation system that punishes waitlisted patients who live in areas that rank lower in terms of social determinants of health and access to care .
UAB Assistant Professor and Surgical Director of the Liver Transplant Program Robert Cannon , MD , FACS , received a K08 career development award from the National Institutes of Health ( NIH ) that will fund his project , “ Geographic Variation in Non-HCC MELD Exceptions and Its Effect on Liver Transplant Waitlist Outcomes .”
Dr . Cannon will be supported by the UAB Transplant Epidemiology and Analytics in Medicine ( TEAM ) Lab , whose mission is to enhance knowledge within the field of transplantation by conducting complex statistical analyses that model transplant outcomes and practices and behavioral research that focuses on eliminating health disparities in transplantation .
“ Researching transplant waitlist policies has a real and major impact on the lives of patients in line to receive a lifesaving organ transplant ,” Dr . Cannon says . “ The UAB TEAM lab seeks to discover the most equitable system of organ allocation , and this is a step in the right direction .”
Flaws in MELD System The current system of liver transplant allocation , known as the Model for End-Stage Liver Disease ( MELD ), assigns candidates a score based on laboratory testing . MELD scores are meant to estimate the risk of dying while awaiting transplant , and patients who are thought to have a higher risk of mortality than reflected in their calculated MELD score are assigned a higher exception or allocation MELD score that is meant to better reflect risk .
A critical flaw in this policy is that it does not account for regional variation in social determinants of health and access to care , which likely have significant effects on waitlist mortality . In short , the risk associated with a given MELD score is assumed to be the same everywhere in the nation . Understanding and accounting for the role of geographic location in the risk of waitlist mortality has the potential to reduce this flaw and improve equity in the liver transplant allocation system .
“ Our hypothesis is that a MELD score of 25 , for example , conveys a different risk of death for a patient in rural Appalachia than it does for one on the upper east side of Manhattan ,” Dr . Cannon says . “ Questions such as these can be answered in a more rigorous fashion utilizing methods from the field of spatial epidemiology than with the standard statistical methods that dominate the current literature on geographic issues in transplantation . In a broader sense , we hope to be able to answer larger questions surrounding geographic disparities in transplantation and better inform policy decisions .”
XENOTRANSPLANTATION : UAB MOVES CLOSER TO HUMAN TRIALS
Despite extraordinary steps the UAB Comprehensive Transplant Institute has taken to increase the availability of donor organs , demand continues to outpace the supply . We hope to overcome this challenge through our groundbreaking Xenotransplantation Program , launched in 2016 with a $ 19.5 million , five-year grant from United Therapeutics Corp ., and we hope to conduct the first clinical trial focused on cross-species ( pig-to-human ) transplants of genetically modified kidneys within the next few years .
In addition to the clinical progress being made , the UAB Xenotransplantation Program is studying psychosocial attitudes , beliefs , reactions , and thoughts of various medical professionals and kidney and heart transplant patients regarding the possibility of pig-to-human organ transplantation . This work will include a series of focus groups with local religious , business , political , and community leaders to further investigate attitudes toward xenotransplantation ahead of expected future clinical trials .
RESEARCH uabmedicine . org / refertransplant 9