The United Network for Organ Sharing (UNOS) has proposed changes to the United States' transplant system in an attempt to reduce the geographic disparity that makes it more difficult to get liver transplants in some areas of the country.

At present, organs are shared among 11 districts in the nation. The proposal seeks to reduce the number of districts to eight districts with redrawn borders. Changing the districts' boundaries would create a better ratio of available livers to waiting recipients.

Heavily populated areas — specifically the Northeast and West Coast — have higher concentrations of people waiting for liver transplants compared to the total number of donated organs. Recipients who live in these areas usually wait longer for an organ, and are therefore sicker when a liver becomes available.

Recipients in the Midwest and South typically don't have to wait as long for organs where the ratios are better. And since they're not as sick when the transplant occurs, these patients usually experience better long-term outcomes.

Patients who need transplants are given a Model for End-Stage Liver Disease score. Scores range from 6 to 40, with 40 representing liver disease patients who are the sickest and most in need of a new organ.

In areas where the recipient-to-organ ratios are the worst, the average organ recipient MELD score is 35, meaning patients are quite sick, usually hospitalized and within days or weeks of dying if a new liver is not available. By contrast, those who receive liver transplants have a MELD score of 23, which indicates they're in better health with an organ becomes available.

"Unfortunately, for many reasons, (right now) there is a big difference in your chances of receiving a transplant based on where you live," said Dr. Ryutaro Hirose, a liver transplant surgeon at the University of California at San Francisco Medical Center and chairman of the UNOS national liver transplantation committee.

During a news conference on Aug. 10, Hirose said reducing disparity among regions would hopefully stop wealthy people from adding their names to more than one waiting list. In 2009, Apple founder Steve Jobs traveled from California where he lived to Tennessee in order to get a liver transplant.

The original districts were drawn in the 1980s, largely for administrative purposes, not as a way of distributing donated organs to recipients. At the time, there were only five transplant centers in the country doing liver transplants.

"There are over 100 [centers doing liver transplants] now," Hirose said. "So the maps created [in the 1980s] really don't help with distribution now."

Hirose said the subject of redrawing districts has come up many times in recent years, but the debate has always been contentious and led to animosity between districts. To combat hard feelings, the proposal includes a "proximity" area that awards three additional MELD points to anyone on the waiting list who lives within 150 miles of the donor.

Before the proposal moves forward, a period for public comment will be held. Public comments will be accepted from Aug. 15 until Oct. 15.