Lisa Waters was 25 years old when, one day in 1995, she couldn’t raise her right arm without pain in her shoulder. Blood tests revealed she had a rare autoimmune liver disease, primary biliary cirrhosis, that can cause liver failure but can be delayed or even forestalled with medication. For the next two decades, Lisa took a drug, Urso, thrice daily and remained in good health. She rose through the ranks at The Gap, eventually becoming a senior vice president, and later left the company to focus on raising her four children in New Jersey.

All was well until one day on Thanksgiving weekend two years ago, when she began vomiting blood for no apparent reason. A friend rushed her to the hospital. “If I hadn’t gone, I probably would have died,” she told me. Doctors at Manhattan’s Mount Sinai Hospital told Lisa that her PBC had progressed and she might need a liver transplant soon—if she could get one in time.

There’s a nationwide organ shortage. More than 115,000 Americans are on waiting lists for organs—mostly kidneys and livers—but because of how transplants are regulated, the severity of the shortage varies by geography. The United Network for Organ Sharing (UNOS), the government-sanctioned organization responsible for allocating organs, divides the country into eleven regions; for the most part, organs must be transplanted within the same region in which they’re donated. But not all regions are equally in need. The two regions that encompass the Deep South’s “stroke belt,” for instance, have less severe liver shortages than elsewhere because of a combination of higher supply and lower demand.

Courtesy of UNOS.org

Lisa had the bad luck of being treated Region 9, where livers are harder to come by. She faced a long waiting list. Being affluent, though, she had more options than the less fortunate candidates in her region. Since UNOS can’t restrict transplant candidates like it does organs, her doctor suggested she get listed in a region with a higher organ supply, to increase her odds of survival. Doing so isn’t simple or cheap. Some hospitals require patients be local for testing purposes, be immediately accessible in case an organ becomes available, and live in the area for up to three months for recuperation, with a caregiver. Out of pocket, liver transplants can cost more than $565,000; even the best insurance plans rarely cover anything beyond the operation and brief post-operation hospital stay.

Lisa chose Duke University Hospital in the mid-southern Region 11, which has a shorter waitlist for livers than Region 9. Her doctors told her that if an organ freed up, she would need to be at the hospital within hours and remain in the area for several weeks for post-operation testing and monitoring. So she moved into a two-bedroom apartment in Raleigh with her sister, who took a leave of absence from work to be her caregiver. Had Lisa stuck with Mount Sinai in New York, she would have waited one to two years for an organ. But just 10 days after moving to North Carolina, she got a call from Duke. A liver was available.