Regulatory oversight discourages certain liver transplants

SAN FRANCISCO — US government rules are unnecessarily discouraging liver transplant centers from performing life-saving transplantations using marginal donor organs or in certain higher risk cardiovascular patients, according to study results presented here at the American Association for the Study of Liver Diseases.

Researcher Anton Skaro, MD, of Northwestern University, said investigators retrospectively examined records of 65,601 adult recipients of deceased-donor liver transplantations performed between 1995 and 2010. The records were part of the database of the Organ Procurement and Transplant Network of the United Network of Organ Sharing.

Anton Skaro, MD

The study concluded that access to liver transplantation for high-risk patients was diminished under the CMS conditions of participation (CoP). Researchers examined trends in the Donor Risk Index and the recipient Cardiovascular Risk Index before and after implementation of the CoP. They found 71% of transplant centers experienced a decline in either or both of the risk indices.

Researchers concluded that regulatory oversight by the CMS has led to the “unintended consequence of risk-averse behavior by transplant centers,” making them less likely to perform transplantations in high cardiovascular risk patients and/or to accept suboptimal donor organs.

Reforms are necessary “to preserve access to liver transplantation among high-risk recipients and sustain the optimal use of marginal donors,” the investigators wrote, concluding “there is a need for mitigating factors that could justify inferior outcomes by transplant centers under specific circumstances.”

For more information:

Wang E. Abstract: Donor and Recipient Risk Aversion in Liver Transplantation. http://liverlearning.aasld.org/aasld/2011/thelivermeeting/16789/donor.and.recipient.risk.aversion.in.liver.transplantation.html Presented at: AASLD the Liver Meeting; Nov. 4-8, 2011; San Francisco.

Disclosure: Dr. Skaro and the researchers report no relevant financial disclosures.