Re "Transplant Inequality: Death by Geography," June 11
The Times' presentation of the geographic imbalances that persist in transplantation illustrates nicely the challenges in seeking a balance of equity, geography and medicine. One geographic factor that merits consideration is that death rates, which are a crude but correlated predictor of potential donors, vary significantly across the country, with California's being 6.7 per thousand while Florida's is 10. Pulsatile perfusion can extend kidney storage time to 48 hours or longer following organ recovery and allow national allocation of perfect-match kidneys. But until science develops similar preservation techniques for livers, hearts and lungs (which must be transplanted within a few hours), time constraints will dictate that geography must play a role in organ allocation.