Success of Pittsburgh VA Healthcare System liver transplant program reveals faults in system
By Debra Erdley
Published: Sunday, Aug. 25, 2013, 9:00 p.m.
The success of a liver transplant program at the Pittsburgh VA Healthcare System is boosting the demand for livers here and highlighting the flaws of an organ allocation system in which the risk of dying can depend upon where you live.
The Pittsburgh VA performed 48 transplants last year. According to government reports, that's more than twice as many as the VA's two other liver transplant centers — in Portland, Ore., and Houston — combined.
As of this month, 186 people awaited liver transplants at the VA facility here. Coupled with 207 people on a waiting list at UPMC and 80 people at Allegheny General Hospital, that leaves nearly 500 individuals waiting for livers.
The United Network for Organ Sharing allocates organs by geographic region, and the number available hasn't increased dramatically. A shortage of livers for transplant exists, and about 1,500 people die each year awaiting a transplant.
Dr. Abhinav Humar, chief of transplantation at UPMC, said those factors mean that people needing transplants in regions with greatest demand might be much sicker by the time an organ is available.
“VA patients come from all over the country to Pittsburgh, and the reason they do is because they've got a great team of doctors and nurses. But the organs don't come with them,” Humar said,
UNOS is considering a new mathematical formula to make organ allocation more equitable by redrawing the nation's 11 transplant regions based on distribution and demand for donated organs.
“This is gerrymandering for the public good. We have applied to transplantation the same math used for political redistricting, school assignments, wildlife preservation and zoning issues,” said Dr. Dorry L. Segev, a transplant surgeon and associate professor of surgery and epidemiology at Johns Hopkins University who led the team that developed the proposed reallocation formula.
Doctors evaluate candidates for a liver transplant according the Model for End-Stage Liver Disease, or MELD, scale that scores each person based on how urgently he or she needs a transplant within the next three months. Those with the highest MELD score go to the top of each region's list.
Humar said the average MELD score at transplantation at the Pittsburgh transplant centers, which was once 26 or 27, climbed to 32 or 33. The average score at transplantation in Indiana and Ohio is 22.
The transplant network's liver committee is considering different map options as it debates how to improve fairness without having to fly organs too far around the country.
“Details of this proposal and its potential local impact have not been fully assessed. We look forward to discussing improved access to transplant care for all those in need,” VA spokeswoman Ndidi Mojay said.
Turf wars might challenge any change because transplant centers with shorter waits understandably don't want them to lengthen, said committee chairman Dr. David Mulligan of the Mayo Clinic in Phoenix.
Dr. Ngoc Thai, a liver transplant surgeon and director of the Center for Abdominal Transplantation at Allegheny General Hospital, said the issue merits great scrutiny.
“I wouldn't immediately jump into changing the geography before I looked at (organ donation and procurement) performance. I think that needs to be a greater initiative,” he said, noting that this region has a better organ donation rate than many.
The Associated Press contributed to this report. Debra Erdley is a staff writer for Trib Total Media. She can be reached at 412-320-7996 or firstname.lastname@example.org.
Show commenting policy
TribLive commenting policy
You are solely responsible for your comments and by using TribLive.com you agree to our Terms of Service.
We moderate comments. Our goal is to provide substantive commentary for a general readership. By screening submissions, we provide a space where readers can share intelligent and informed commentary that enhances the quality of our news and information.
While most comments will be posted if they are on-topic and not abusive, moderating decisions are subjective. We will make them as carefully and consistently as we can. Because of the volume of reader comments, we cannot review individual moderation decisions with readers.
We value thoughtful comments representing a range of views that make their point quickly and politely. We make an effort to protect discussions from repeated comments either by the same reader or different readers.
We follow the same standards for taste as the daily newspaper. A few things we won't tolerate: personal attacks, obscenity, vulgarity, profanity (including expletives and letters followed by dashes), commercial promotion, impersonations, incoherence, proselytizing and SHOUTING. Don't include URLs to Web sites.
We do not edit comments. They are either approved or deleted. We reserve the right to edit a comment that is quoted or excerpted in an article. In this case, we may fix spelling and punctuation.
We welcome strong opinions and criticism of our work, but we don't want comments to become bogged down with discussions of our policies and we will moderate accordingly.
We appreciate it when readers and people quoted in articles or blog posts point out errors of fact or emphasis and will investigate all assertions. But these suggestions should be sent via e-mail. To avoid distracting other readers, we won't publish comments that suggest a correction. Instead, corrections will be made in a blog post or in an article.
- Century III new owner seeks to reverse vacancy trend with new theater
- Corrected performance profiles provided for Pennsylvania schools
- Hill District nonprofit’s finances are taking another dive
- Newsmaker: Richard L. Byrne