UNOS plan would challenge the current system that many feel fails regarding offering fair access to deceased donor liver transplants due to geographical disparity

By m.s.

September 17, 2014

Public forum addresses equity in liver distribution

The survey results are here.

Rosemont, Ill. – Approximately 400 people attended a public forum held on Sept. 16 to discuss various concepts to reduce geographic variation in access to liver transplantation.

The opinions and recommendations expressed will help theOPTN/UNOS Liver and Intestinal Organ Transplantation Committeeas it continues to assess potential improvements to liver transplant policy.

“At this point, no specific policy recommendation has been determined,” said Carl Berg, M.D., OPTN/UNOS President. “But this ongoing discussion has identified a number of areas of focus, as well as key questions and concerns that need to be answered in developing any future proposal.”

The forum addressed concepts distributed for public input in June 2014. Results of a questionnaire that accompanied the document were also shared and further discussed at the forum.

The OPTN/UNOS Liver and Intestinal Organ Transplant Committee is discussing feedback from the questionnaire and the forum at its regularly scheduled meeting today.

Source UNOS

Now for the details of this issue:

I have written about challenging the current system and how it fails regarding offering fair access to deceased donor liver transplants due to geographical disparity.

The following is based on my opinion and observations with respect to this issue.

Some in the transplant community support fairness and eliminating the issue of unfair access to a life-saving deceased donor liver transplant. It is a well settled fact that liver transplant candidates in some parts of the country must wait until they are much more ill before receiving a liver transplant while candidates in other areas of our nation may receive a liver transplant when they are much less ill.

The butterfly represents organ donation as a symbol of change and is also well established as representing new life and hope. The butterfly has been chosen by donor families and the National Donor Family Council to be one symbol most associated with The Gift Of Life; organ donation.

Over 50 liver transplant physicians are against changing deceased donor liver allocation policy to help eliminate the geographical disparity. They are quite active and took action all summer. We have no idea how many transplant physicians who are in favor of changing deceased donor liver allocation policy to help eliminate the geographical disparity took action and wrote to UNOS and met with members of Congress.

It was a bipartisan group of 52 members of Congress that signed the letter today (Friday, 18 September) condemning the plan. These members of Congress sent a letter because those 50 or more transplant physicians (including liver transplant surgeons and others who specialize in transplantation), mostly from the Midwest and Southeast of the United States oppose the proposed plan and that group of 50 transplant physicians sent sharply worded letters to the HHS all summer. That group of over 50 transplant physicians described the plan and slammed the proposal in writing using strong language such as “This plan is the most change in liver allocation ever.”

As an aside, how many transplant candidates and recipients do you think wrote to Congress or even answered the UNOS survey regarding UNOS’ first attempt at having the public and transplant community comment about this proposed change?

Have you weighed in and told UNOS your feelings, opinions and answers to the questions on their survey?

So far, the squeaky wheel is getting the most attention and that happened with all changes in deceased donor allocation even though many people voiced their opinion (verbal and unofficial internet forum comments) that never counted.

There seems to already be huge regional and national political posturing especially on the part of liver transplant surgeons in the Southeast and Midwest who are so far most vocal via official channels. It’s important to consider their side of the story even if one disagrees. I always want to consider both sides of an issue. Their side of the story includes citing statistics and here are three of them:

•About 15,600 people are currently waiting for a liver transplant, including 3,000 in California and 1,300 in New York, according to HHS data. There are just 129 people on the wait-list in Kansas and 252 in Georgia.

•The rates of organ donation vary widely across geographic regions. Rates are highest in the Southeast and Midwest, which also experienced the nation’s highest death rates.

Note: They refer to their Southeast and Midwest regions as donor rich.

•Under the plan, states with larger supplies of livers-such as Kansas and Tennessee-would share their donations with states like California or New York, where organ donation is less common.

On the other hand, I will present a stat as well:

Death rates for people awaiting liver transplants range from 14 percent to 82 percent depending on their state, according to a 2013 report by the American Journal of Transplantation.

It’s my personal opinion that this is not the best that can be done in our nation with respect to deceased donor liver allocation. I feel that equalizing MELD scores (a measure of severity of liver disease) is fair. To date, the surgeons in the Southeast and Midwest regions do not want equalized MELD scores.

The UNOS Liver and Intestinal Organ Transplantation Committee’s plan would reduce the number of regions and increase the sharing of deceased donor livers in order to save more lives.

The UNOS Liver and Intestinal Organ Transplantation Committee estimates that changing the number of regions to four would lead to a reduction of 581 deaths of people on a liver transplant waiting list. Having eight regions, another possibility, would cause a reduction of 342 deaths.

Sources: American Journal of Transplantation, The Hill, UNOS

Read more about this issue here. or continue reading below and click on “Read more” for additional an opinion piece and reference material.

Let Liver Transplants Go Where They’re Needed

September 11, 2014

About 3,000 people die in the U.S. each year for lack of a liver for transplantation. More than 100 of those lives could be saved by ensuring that more of the 6,000 or so livers donated annually in the U.S. go to those who need them most.

Under the existing system, managed by the United Network for Organ Sharing, donated livers are prioritized for use in the regions from which they come. In places where the organs are relatively plentiful—the South, for instance, where death rates are higher—they sometimes go to people who could easily wait longer for a transplant, rather than to sicker patients who may die without them. As a result, the death rate for patients on a liver wait list can vary by a factor of 10 from one part of the U.S. to another.

A new system, put forward by a UNOS committee, would redraw the liver-donation map to create four regions in place of the 11 that exist today. Mathematical models suggest that sharing livers within these zones would save 554 lives over five years.

Granted, recovery teams would have to travel farther. The share of livers that would need to be transported by air would rise to about 3 in 4—from less than 1 in 2—because a liver must be transplanted within 18 hours of removal from a blood supply. Even so, total costs would decline by 4.3 percent, or about $246 million, thanks to savings on expensive care for people with end-stage liver disease.

So what’s not to like about the change? Liver patients and their advocates in areas where it’s now relatively easy to receive an organ fear they would lose out. It’s true some would have to wait longer. But their more robust health would enable them to do so.

Another objection sometimes raised is that expanding the zones would reduce donations, because people would no longer know that individuals in their own communities would receive their donations. Research contradicts this notion: in a 2013 survey, 82 percent of respondents said they would prefer their organ go to the person in greatest medical need, regardless of location.

It’s that concept that should guide the distribution of donated livers nationally. In the age of overnight delivery service, Americans’ access to lifesaving organs shouldn’t depend on where they live.

Source: business week/bloomberg