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Comment & Response |

Liver Transplants Among US Veterans—Reply

David E. Kaplan, MD, MSc1; David S. Goldberg, MD, MSCE2
[+] Author Affiliations
1Gastroenterology Section, Philadelphia VA Medical Center, Philadelphia, Pennsylvania
2Division of Gastroenterology, Department of Medicine, University of Pennsylvania, Philadelphia
JAMA. 2014;312(4):437. doi:10.1001/jama.2014.7158.
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In Reply We concur with Dr Gunnar that distance-related inequities in access to liver transplantation are not unique to the VHA. However, the absence of robust national databases precludes such evaluations in the non-VA population. The VHA’s integrated electronic medical record allowed us to use the VHA as a model of the effects of centralization and there was no intent to imply that these are VHA-specific disparities. Unlike private centers, the VHA attempts to minimize the additional burden of distance by providing travel assistance to veterans and caregivers; however, such support does not ameliorate the reduced access to transplantation for veterans living more than 100 miles from a VATC.

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July 23, 2014
William P. Gunnar, MD, JD
1Veterans Health Administration, Washington, DC
JAMA. 2014;312(4):436-437. doi:10.1001/jama.2014.7152.
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