OPTN/UNOS to hold public forum on liver donor distribution

The Organ Procurement and Transplantation Network and United Network for Organ Sharing Liver and Intestinal Organ Transplantation Committee will host a public forum on Sept. 16 in Chicago to discuss current liver distribution issues, including the committee’s controversial concept paper distributed in June.

The paper is available on the organization’s website and suggests strategies to close the gap between “geographic disparities” and create ways for all candidates to have better access to liver transplantation. Liver distribution currently uses a “local, regional, national algorithm” that is based on locations between hospitals where organs are recovered and transplant hospitals where potential candidates are listed, the paper said. The committee’s paper suggests changing the distribution from a regional to a national level.

“A leading method under consideration … is distribution based on districts that were mathematically optimized to reduce the variation in the median MELD at transplant,” the committee wrote. “Additionally, statistical and simulation modeling strongly suggests that using optimized geographical allocation districts would likely reduce both wait list deaths and variation in the MELD or PELD scores at transplant.”

Doctors at The University of Kansas Hospital and 45 transplant programs nationwide, however, oppose changing the current distribution system for fear that more lives will be lost and many candidates will miss an opportunity for a transplant, according to a hospital press release. The hospital said the newly proposed plan would increase liver transplantation costs by $30 million annually.

Timothy Schmitt

“The only way to save more lives is to increase organ donation in other regions,” Timothy Schmitt, MD, director of transplantation at The University of Kansas Hospital, said in the release. “Flying livers across the country from high-donation regions to lower-donation regions removes any incentives for those donation programs to get better.

“By simply reallocating where livers go without increasing donations, you only change where people die waiting for a liver,” Schmitt said. “Areas which can transplant at a lower MELD score only do so because of the generosity and spirit of donation in those communities.”

According to the release, the Midwest Transplant Network has shared more than 50% of all donated organs with other regions and 34% of all livers with other regions last year, illustrating how the region’s donation rate already helps other parts of the country. In addition, the network, Gift of Life, donor families, Region 8 organ recipients and health care leaders are asking the public to register to donate organs in all regions nationwide.

“The foundation of all organ transplants is the gift of donation,” Schmitt said. “Increasing donations should be the No. 1 priority, instead of spending resources on a risky allocation plan.”

“We know UNOS is working with every resource available to find a better way, but it is not good medicine to rush into radical change without a good understanding of unintended consequences,” Richard Gilroy, MD, medical director of liver transplantation at The University of Kansas Hospital, said in the release. He also had concerns about longer traveling times for the livers if they are distributed nationally.

Richard Gilroy

“With the new proposal, there will be more cold time on organs shared nationally instead of regionally,” Gilroy said. “It will be on ice longer and it may not work as well.”

The forum is open to the public, and interested parties also may participate through a webinar.

For more information:

http://optn.transplant.hrsa.gov/news/newsDetail.asp?id=1658.