UNOS Approves New Liver Transplant Distribution Plan

The United Network for Organ Sharing yesterday approved
new rules for the distribution of "scarce" livers, helping ensure that the sickest patients are placed at the top of the waiting list for transplants, the
New York Times reports. The current distribution system for livers places patients who have been on the transplant waiting list longest at the front of the line, but the UNOS plan would rank patients according to medical need. The proposal is based on the Mayo End-Stage Liver Disease system developed at the Minnesota-based Mayo Clinic, which experts say is "extremely effective in predicting which patients will die without a transplant." Patients seeking liver transplants would take a blood test that places them in one of up to 60 medical need categories compared to the current four-category system.

Dr. Richard Freeman, a liver transplant surgeon at Boston-based New England Medical Center who presented the UNOS proposal, said the new system would replace the "subjective parameters" used in the current system, which could be interpreted differently by different doctors. Freeman said, "The new system eliminates that subjectivity. ... Blood tests don't lie." However, patients currently waiting for liver transplants "will not see immediate changes" in the distribution system, as the proposal pends approval from the federal Health Resources and Services Administration branch of HHS. Approving the new rules could take "several months." Meanwhile, UNOS will begin collecting blood samples to start ranking patients but will not actually change the ranking order until HHS approves the new system (Stolberg, New York Times, 11/17). HHS officials said they were "prepared to accept the proposal, at least for now" (Meckler, AP/Philadelphia Inquirer, 11/17).

The UNOS plan falls short of HHS' goal to break down the geographical barriers of liver distribution. The network board, divided on the issue, declined to change the "arbitrary boundaries that divide the nation for transplant purposes," the AP/Baltimore Sun reports. HHS had ordered UNOS to redraw boundaries to reduce geographic disparities, but a UNOS subcommittee concluded that "while redrawing boundaries would balance the supply of organs" across different regions, "it would save only a handful of lives" (AP/Baltimore Sun, 11/17). UNOS had considered 17 different plans for sharing livers across broader areas, but concluded that none of them would save a "substantial" number of lives (AP/Philadelphia Inquirer, 11/17). John Nelson, the HHS administration's official in charge of the distribution system, conceded that the network's proposal is "a step in the right direction." He added, "Our goal isn't broader sharing. Our goal is a fairer system" (New York Times, 11/17).

Meanwhile, a new organ distribution system has been developed to help federal inmates obtain kidney transplants, the Washington Post reports. Earlier this year, the Bureau of Prisons reversed its "long-standing" policy of refusing to provide inmates with organ transplants and will now finance transplants in "some circumstances." Bureau Assistant National Health Systems Administrator Jan Sorenson said the agency was unwilling to change the policy until transplant success rates were "very high" and the procedure became "the community standard." Since the new policy's approval, however, several inmates have still been "unsuccessful ... in their efforts to be evaluated for possible transplants," the Post reports. Instead, most inmates are placed on long-term dialysis, which costs about $40,000 annually per patient and has a "much higher" death rate than kidney transplants. Sorenson said that because of a scarcity of organ donors, "not all transplant programs are willing to consider placing prisoners on their waiting lists for kidneys." Bureau officials are currently drafting a contract that will be bid upon by medical centers willing to provide kidney transplants to federal inmates. Sorenson said, "We're going to have to see how the transplant centers react to having inmates worked up and put on their candidate lists" (Okie, Washington Post, 11/17).