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Transplanting Too Soon

Day 1: How liver surgeries cut short patients’ lives

March 9, 2008
By Luis Fábregas and Andrew Conte
Hundreds of patients each year undergo liver transplants when they don't need them, and possibly never will, a four-month Pittsburgh Tribune-Review investigation found. One in 10 of those patients dies when they could have lived …


Day 1: Rejected livers often land in Indianapolis

March 9, 2008
By Luis Fábregas and Andrew Conte
INDIANAPOLIS -- Calls come in from across the United States, around the clock. Organ procurement agencies have livers that are about to be thrown out unless Clarian Health, based here, wants them. Often, it does. …


Day 1: MELD 15 hasn't become magic number

March 9, 2008
By Luis Fábregas and Andrew Conte
The nation's liver allocation system had to be fixed. Far too many livers were being taken to transplant centers that were using them on patients on the lower end of the wait list. Sicker patients in the same region of the country never had a chance of getting them. From …


Day 1: Offer of a liver only the beginning of a long road

March 9, 2008
By Luis Fábregas and Andrew Conte
Michael Weekley wanted to wait for the liver transplant. He'd been feeling healthy after years of battling liver disease and told his sister he didn't want a new liver just yet. "You wouldn't have known he was sick," said Weekley's sister, Connie Mayes of Chester, W.Va. "He was not in …


Day 2: Treat sickest first, or give livers to the less ill?

March 10, 2008
By Luis Fábregas and Andrew Conte
The father of transplantation felt bewildered. The transplant center bearing Dr. Thomas E. Starzl's name at the University of Pittsburgh Medical Center now does the very surgeries that doctors there once shunned, even mocked. Transplantation …


Day 2: Starzl institute: 'Nobody has a unit like this'

March 10, 2008
By Luis Fábregas and Andrew Conte
On a recent clinic day at UPMC Montefiore, dozens of liver and kidney transplant patients clogged the seventh-floor waiting room. A man with jaundiced skin wrapped his fingers around a Styrofoam coffee cup. A woman, not older than 30, watched a portable DVD player. Yet another man in a wheelchair …


Day 2: 'The sicker they are ... you see a miracle'

March 10, 2008
By Luis Fábregas and Andrew Conte
MIAMI -- Dr. Andreas Tzakis cuts open the woman's belly to reveal her sick liver. Its surface is bumpy and dark pink. "It's supposed to be smooth and light pink," Tzakis said, his mouth covered …


Day 2: Medical ethics issue focuses on 'doing no harm' to patients

March 10, 2008
By Luis Fábregas and Andrew Conte
With a limited supply of organs, liver transplant surgeons must worker harder to maintain the guiding principle of doing no harm, medical ethicists said. Give a liver to a patient too soon, and the doctor could cut short the person's life or unnecessarily burden them with having to deal with …


Day 3: Doing fewer transplants cuts money, prestige

March 11, 2008
By Luis Fábregas and Andrew Conte
INDIANAPOLIS -- Lying in an intensive care unit four days after surgery, Jeff Hagan praised surgeons here for giving him a liver when others wouldn't. Doctors in Chicago, near Hagan's home in Bartlett, Ill., told …


Day 3: Surgeons, others see a need for changes

March 11, 2008
By Luis Fábregas and Andrew Conte
Trying to save lives is not enough. Liver transplant surgeons said they must balance each patient's survival odds against the vitality of their overall transplant program. Medicare and Medicaid, the federal reimbursement programs, can prevent …


About the data

March 11, 2008
By The Tribune-Review
• Despite a federal rule designed to limit the number of liver transplants in patients who aren't critically ill, four of the nation's 127 programs have done half of the 846 such transplants since 2005. The programs, by volume of transplants, are Clarian Health in Indianapolis, Pittsburgh's UPMC, Mayo Clinic …