LIVER TRANSPLANTS: UNOS Shifts Focus to Sickest Patients
After wrangling with the HHS for 15 months over organ allocation policies, the United Network for Organ Sharing yesterday agreed that it would direct donor livers to the sickest patients first in any given region, the Los Angeles Times reports. While the policy shift does not go as far as the HHS advocates -- distributing organs nationwide according to the most in need -- it nonetheless "represents a dramatic softening of resistance by UNOS." In agreeing to "overhaul the system," UNOS said that under the new guidelines, it would give top priority to "Status 1" patients, or those thought to have a week or less to live. Under the current system, a liver is first offered to a local Status 1 patient, and if there are no matches, the organ is then offered to others on the waiting list in the same region, regardless of medical urgency. If there are still no matches, the organ is then offered to regional candidates. Under the new policy, if there are no local Status 1 patients, the organ would then be offered to Status 1 patients in the region before being offered to less urgent local candidates. UNOS said the new rules will likely increase the number of transplants performed on the most urgent patients from 14% to 22% and "reduce their waiting time from four days to two days" (Cimons, 6/25). The network has gone head-to-head with HHS, contending that move to offer organs to the sickest patients would decrease overall survival rates and endanger less-urgent patients by making them wait until they have deteriorated to Status 1 before they can receive an organ (Kronholz, Wall Street Journal, 6/25). Nonetheless, UNOS "saw some benefit from the new policy." Dr. Jeremiah Turcotte, chair of the network's liver and intestinal organ transplantation committee, said, "We think this ... strikes a good balance. It achieves these changes without disrupting the capacity of individual transplant centers to treat patients or significantly increasing the overall death rate among transplant patients." HHS spokesperson Campbell Gardett said that while the move is a "step forward," it falls short of addressing the needs of those patients in the "middle" (Los Angeles Times, 6/25).
Local transplant centers winced at the ruling, the Pittsburgh Post-Gazette reports. Dr. John Fung, director of transplantation at University of Pittsburgh Medical Center, said that because Status 1 patients account for only 5% of its waiting list, it is unlikely to bring more organs to the center. A better move, he said, would have been to expand the candidates to Status 2a -- chronic liver failure patients -- because there are twice as many. UNOS spokesperson Bob Spieldenner said that giving preference to the 2a patients too would have "dramatically" increased the number of deaths (Snowbeck, 6/25). Debi Palmeri, liver transplant coordinator at Hartford Hospital agreed with Fung, saying that her hospital rarely sees a Status 1 candidate. "Someone figured that people with acute liver disease were more deserving than people with chronic disease," she said, noting that only 10% of patients with chronic liver disease have abused alcohol (Waldman, Hartford Courant, 6/25). The UNOS yesterday also outlined a process for transplant centers to share "split livers," and it agreed for the first time to release performance information on individual transplant centers (Pittsburgh Post-Gazette, 6/25).