Congress of the United States ‘Washington, AE 20515 November 7, 2014 Mr. Brian Shepard Chief Executive Officer United Network for Organ Sharing PO Box 2484 Richmond, Virginia 23218 Dear Mr. Shepard: We write to express our deep concerns with geographic disparities in the distribution of donor kidneys in the area of Texas that we represent and to urge expedited consideration of this issue. We have reviewed your response of August 11, 2014, and maintain that the United Network for Organ Sharing (UNOS) is not acting expeditiously enough to meet the urgent needs of our constituents who face inordinate wait times on donor kidney lists, compared to their fellow Texans in other parts of the state. We read with interest the editorial of Dr. Kenneth A. Andreoni, Immediate Past President of OPTN/UNOS and a past chair of the OPTN/UNOS Kidney Transplantation Committee, and Dr. Richard N. Formica, Jr., Chair of the OPTN/UNOS Kidney Transplantation Committee, in the American Journal of Transplantation, Drs. Andreoni and Formica write that “(t]he arbitrary boundaries of donor service areas (DSAs) are the impediment to equitable access to patients and Texas, although not unique, is a case study in how gerrymandering DSAs to serve individual transplant center agendas results in disenfranchisement of patients.” We appreciate the points that the authors have made and that you have made regarding the complicated task of defining allocation equity and then designing a new system that is more equitable. We also understand that the recent changes to the Kidney Allocation System, which will allow wider sharing of high “kidney donor profile index” (KDPI) kidneys, may impact wait times for donor kidneys. However, delaying further consideration of an overhaul of the kidney allocation system until after the new KDPI allocation is “implemented and stable” and until after the work of the Liver Transplantation Committee is complete will cause an unnecessary delay in bringing relief to our constituents. Given that the OPTN/UNOS Board agreed nearly two years ago that “geographic disparities in candidate access to transplant are unacceptably high,” as you state twice in your response, it is also unacceptable to further delay the Kidney Transplantation Committee's work in proposing a solution to this crisis, We see no good reason why the work of the Kidney Transplantation ‘Committee cannot continue while the KDPI program is implemented and while the Liver Transplantation Committee makes it proposal at some point next year.‘We urge you to reconsider UNOS’s position on the timing of the Kidney Transplantation Committee's consideration of this vital issue and to ensure that work is being done at each subsequent meeting to develop a proposal for a more equitable distribution of donor kidneys across the state of Texas and the country. Sincerely, Det oe. loyd Doggett Rubén Hinojosa i of lar Cat pit