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Proposal to improve liver transplant system would rework prioritization

Ben Schmitt
| Monday, Aug. 21, 2017, 11:00 p.m.

A proposal to revamp the country's organ transplant system could help distribute livers equitably to candidates in dire need.

The initiative by the United Network for Organ Sharing would not redraw existing donor sharing districts, as previously proposed.

Officials from UNOS on July 31 unveiled the plan with a goal of assisting the sickest patients awaiting transplants.

“Obviously, it would seem fairer to give the liver to the sickest patient in all cases,” Dr. Julie Heimbach, chair of the liver and intestinal transplantation committee at Organ Procurement and Transplantation run by UNOS, told the Tribune-Review. “Logically, that is not possible.”

There are more than 14,000 people on the waiting list for a liver transplant, according to UNOS. Last year, 7,496 Americans received liver transplants from deceased donors.

The Northeast, including Pennsylvania, has a relatively large number of people awaiting liver transplants compared with livers available, local doctors said. Persuading other regions to share could be difficult, said Dr. Christopher Hughes, UPMC's surgical director of liver transplantation.

“Because UNOS works on a vote by consensus, there's always going to be a drawn line between regions wanting more organs and regions not wanting to give up the organs they have,” he said. “I'm not putting blame on anybody. I understand that every transplant surgeon wants to do what is best to save his or her patient. And every transplant center wants to be successful.”

Several models for distributing organs have been considered and rejected over the past five years, including one in 2016 that would have reduced transplant regions from 11 to 8.

Under the newest proposal, transplant candidates at increased medical urgency listed at hospitals within 150 nautical miles (173 miles) of a donor hospital could receive a liver from a donor even if they are in different transplant regions.

Another key component in selecting candidates for transplant is their likelihood to die without a transplant within three months. A scoring system called MELD, which stands for Model for End-Stage Liver Disease, ranks liver transplant candidates on a scale ranging from 6 for the least ill to 40 for those at greater risk of death.

Heimbach said MELD scores vary greatly within the 11 transplant regions. Under the current system, a dying patient living close to the edge of one region might not be considered for a liver transplant while someone who is less sick and lives across the border receives a liver.

“In short, in some areas, you can be transplanted with a lower degree of illness rather than others,” she said.

The new proposal designates high-priority patients to have a MELD score of at least 29, granting them the ability to cross transplant region borders for livers.

Public comment to UNOS' Liver and Intestinal Organ Transplantation Committee is open until Oct. 2. The committee will consider all remarks before sending the proposal to the board for a vote.

Hughes, of UPMC, said the proposal could be helpful to Western Pennsylvania patients in need of livers. However, he believes last year's proposal to redraw transplant regions would have better benefitted the area.

“People have a lot of hard feelings over this,” he said. “They want to keep what they have. There is a problem of unequal distribution of livers across the nation, and we've known this since the 1990s.”

Ben Schmitt is a Tribune-Review staff writer. Reach him at 412-320-7991, bschmitt@tribweb.com or via Twitter at @Bencschmitt.

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