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Rule change would aid some who await organs

A proposed change in the way intestinal organs are allocated could increase access to those organs for people awaiting transplantation, according to a UPMC surgeon who is leading efforts to change federal rules.

The proposal affects people who are waiting for a combined liver-intestine transplant, a type of procedure that has sharply declined in frequency since 2008.

Surgeons attribute the drop in the combined surgeries to a federal rule that requires livers to be offered to every patient on the national waiting list. Doing so pushes down the list about 70 adults nationwide who are waiting for a combined liver-intestine transplant during any given year.

"It's unfair," said Dr. Kareem Abu-Elmagd, director of UPMC's Intestinal Rehabilitation and Transplantation Center. "Too many patients were at risk of dying."

Death rates among adults awaiting a liver-intestine transplant are nearly three times higher than those waiting for just a liver, according to a proposal drafted by members of the Liver & Intestinal Organ Transplantation committee of the United Network for Organ Sharing, a nonprofit agency contracted by the federal government to manage organ allocation nationwide.

Dr. Kim Olthoff, chairwoman of the committee, said the proposed rule would reduce the wait list mortality without risking the availability of organs to people awaiting livers alone.

"The liver committee feels it's a good thing; otherwise they wouldn't have put the proposal forward," said Olthoff, a professor of surgery at the University of Pennsylvania in Philadelphia.

Under the proposed change, transplant candidates waiting for both liver and intestines would get increased priority on the wait list. They would be offered organs after livers are offered to local and regional candidates ranked with a score of 29 or higher on the Model of End-stage Liver Disease scale, which ranks patients for transplant eligibility based on scores of 6 for the least sick to 40 for the sickest. The proposed rule change must be approved by the UNOS board.

"It's one step forward," Abu-Elmagd said of the proposed change. "It's better than nothing."

UPMC had performed upward of 20 liver-intestine-pancreas transplants prior to 2008. Last year, only three were done, according to UNOS data.

The one-year survival rate for adult intestinal transplants at UPMC last year was 89 percent, compared with a nationwide average of 75 percent, according to data from the Scientific Registry of Transplant Recipients.

Former UPMC patient Greg Dawson of New Bremen, Ohio, expressed hope the new rule will be approved. Dawson, 45, underwent a combined liver-small bowel transplant in March 2003 because a hereditary illness called Gardner syndrome was destroying his organs. He is now healthy.

While he didn't have to wait long, his brother, Jeff, waited for more than eight weeks for a transplant in 2008.

"That's terrible that some people have to wait and wait," Greg Dawson said. "It's pretty amazing to have this opportunity."

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