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Transplanting Too Soon

Day 1: Rejected livers often land in Indianapolis

| Sunday, March 9, 2008
Dr. A. Joseph Tector, head of transplantation at Clarian Health in Indianapolis, reviews the charts of a 51-year-old Hepatitis C patient about to undergo a liver transplant. Andrew Russell | Tribune-Review
Dr. A. Joseph Tector, head of transplantation at Clarian Health in Indianapolis, reviews the charts of a 51-year-old Hepatitis C patient about to undergo a liver transplant. Andrew Russell | Tribune-Review

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. Even if a liver has been rejected by doctors for thousands of the sickest patients, Clarian's transplant chief, Dr. A. Joseph Tector, will take a second look - unless the donor is older than 60 or the organ has been outside a body longer than 12 hours.

"It's like shopping for cars, OK, and it's your 16-year-old kid who needs a car," Tector said. "They don't need a Maserati. They need to get to school. They need to be able to drive to practices and stuff like that, and that's it. So that car doesn't have to be the greatest car in the world for them to have a very good quality of life. These organs are no different."

Tector, who got his start in Pittsburgh, has built Clarian into a top program, largely by performing transplants on patients who are not critically ill - often giving them livers that have been turned down by others.

Since 2005, Clarian has done 137 transplants surgeries on patients at the bottom of the nation's waiting list. It did more such surgeries than any other program in the United States, and the transplants made up more than a third of the liver program's total caseload.

As a result, patients at Clarian do not wait long for livers. Despite using livers rejected by others, Clarian often makes them work. It posted a higher-than-expected organ success rate in the latest report from the federally backed Scientific Registry of Transplant Recipients, which tracks and analyzes organ transplant data.

A year after transplant, 89 percent of Clarian's transplant recipients remained alive, slightly higher than the center's expected rate. The national rate is 82 percent, but many of the centers comprising that number treat a higher percentage of sicker patients, who have lower survival odds.

Tector's unpublished research shows his patients have better long-term survival odds if they undergo transplant surgery before becoming very ill. What is unclear is how those patients would have fared with no transplant.

"If you are a patient with a low-MELD score, it doesn't matter if you are going to have a better survival than somebody with a high-MELD score," said Dr. Robert Merion, the registry's clinical director. "It only matters whether your survival, at your low-MELD score, is better with a transplant than without a transplant."

After looking at Merion's research, Dr. Steven Rudich at the University of Cincinnati stopped doing most liver transplants on people with low-MELD scores.

"With a MELD of 15, your one-year survival is practically a hundred percent" without a transplant, he said. "Your one-year survival with a MELD of even 17 or 18, my friend, is pretty damn good."

Other unpublished Clarian research shows the center reaching essentially the same results, no matter whether it used a liver that came from nearby or one from hundreds of miles away that had been turned down at other centers.

Tector said he tells patients what they need to know - or ask - about the donor organ.

"Basically what we tell people is that 'Cinderella's dead. Snow White is dead. You are not getting their liver,' " Tector said.

Luis Fábregas can be reached at or 412-320-7998. Andrew Conte can be reached at or 412-320-7835.

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About the data
• 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 ...
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