Surgeons Take Sides on Transplant Proposal
By Tinker Ready
Proponents claim a new donor liver allocation plan would be more equitable for patients; foes say it could raise costs and close programs.
A proposal to change how donor livers are distributed has reignited the battle over which patients should be considered first for transplants.
Currently, organs donated in one of the nation’s 11 designated geographic districts are generally offered to patients in a smaller area served by a designated local organ procurement agency. However, districts with many transplant candidates are not necessarily the districts with the most donors.
Although all areas of the country have long lists of transplant candidates, those in some districts must wait longer for a donor liver, or be more ill, than patients in other districts.
The latest plan comes from a joint committee including the federal Organ Procurement and Transplantation Network(OPTN), and the United Network for Organ Sharing (UNOS), which manages the nation’s transplant system.
The OPTN/UNOS plan would create eight larger districts apportioned to allow more equitable access for those in need of liver transplant regardless of their place of residence, according to the plan.
With some exceptions, organs would be shared across these larger districts for seriously ill patients before they would be offered locally.
The current system is tilted toward keeping organs local, says Ryutaro Hirose, MD, a transplant surgeon at the University of California San Francisco Medical Center and chair of the committee that is proposing the new rule.
“A lot of us believe these organs don’t belong to one area or center,” he says. “Organs are national resource, not a local or provincial one.”
The debate over this issue goes back 35 years, Hirose says. In 2000, the Department of Health and Human Services (HHS) instructed OPTN and UNOS to come up with a policy to address differences in access to organs.
Under the new proposal, some centers will lose volume and costs may go up in some cases, but access will be more equitable, Hirose says.
“We want to be the best possible stewards of these organs,” he adds.
Opponents of the new plan worry the proposal could force some programs to close, further limiting or delaying access for some patients, says Sean Kumer, surgical director of transplantation at The University of Kansas Hospital, who opposes the plan.