The mean "varied from 14 to 1313 days." Two weeks to nearly four years, on average, for kids in whole donor service areas. DSA boundaries and the limitations of sharing across them are among the greatest challenges facing us as we continue to move closer to balancing equity, justice, and utility in deceased donor organ allocation. The legacy of tiny geographic sharing areas from the dawn of transplantation practice is not serving us decades later. Broader sharing is coming, with nationwide allocation a greater possibility than ever with the new kidney allocation system.
Broader liver and heart sharing has been in progress for years. The direct mail campaign to OPTN/UNOS board members by transplant centers in "supply" DSAs was an education in itself, as they argued that this was zero sum and they would be the losers. No investment in commercial appeals for broader sharing were necessary. The inequity of the huge difference in wait time between Manhattan and its neighbors, one among many, many possible examples, is clear. Solutions are difficult, as they involve change, and money, and entrenched vested interests. Even so, progress is being made. This article highlights why progress must continue.