Equity of access to liver transplantation in the UK (EquiLT-UK) v1
Research type
Research Study
Full title
Equity of access to liver transplantation in the UK: impact of socio-demographic characteristics on registration, organ offering, allocation and transplant outcomes
IRAS ID
340728
Contact name
Ji Jade King
Contact email
Sponsor organisation
NHS Blood and Transplant
Duration of Study in the UK
3 years, 0 months, 4 days
Research summary
Inequalities in healthcare are being increasingly acknowledged, and people from disadvantaged backgrounds have been described to suffer from greater rates of morbidity and mortality. National reports have shown that individuals who come from the most deprived areas of the country are subject to higher liver-related mortality (Alleway et al., 2013; Parliamentary Under Secretary of State for Public Health and Primary Care, 2019). In people with end stage liver disease liver and certain liver cancers transplantation can provide a cure and extend life expectancy. Whether social inequalities influence access to and outcomes from liver transplantation is uncertain.
We aim to determine whether there are inequities already established within the current liver transplant selection process, and to assess if they were exacerbated by the COVID pandemic, when access to care generally was restricted. The impact of sociodemographic characteristics – including Socioeconomic status (SES), ethnicity, age, sex, etc. - on outcomes of the liver transplant process will be assessed, from registration to 5-years post-transplant across the UK.
To gain information required for risk adjustment, routinely collected electronic healthcare data of the patients listed in England - recorded by NHS England hospitals over the past 20 years (acute or routine admissions, cancer diagnosis, and mortality) - will be collated and linked to the UK Transplant Registry (UKTR) Liver waiting list held by NHS Blood and Transplant. Comparison will be made to determine which sociodemographic characteristics are associated with higher odds of being listed or dying in the community. Data analysed by the research team will contain pseudonymised information.
As new healthcare pathways are being implemented and referral networks consolidated, this work represents the opportunity to establish whether all those in need, including vulnerable and marginalised populations, are fairly represented in the group proceeding to liver transplantation. If inequities are established, it will provide the justification to design strategies to ensure systematic bias within liver transplant services and organ transplantation are monitored, addressed, and audited.REC name
London - South East Research Ethics Committee
REC reference
24/LO/0674
Date of REC Opinion
13 Sep 2024
REC opinion
Favourable Opinion