Doctors at the University of Kansas Hospital have teamed up with dozens of other transplant programs to urge delay of a proposal that would change how livers for transplant are distributed around the country.
The proposal, scheduled to be taken up in Chicago in mid-September, would have a profound impact on KU Hospital, which runs one of the top liver transplant programs by volume in the country, and other regional transplant centers.
Currently, donor livers are shared among the sickest patients within each of 11 regions in the country. KU benefits from that arrangement because organs are donated at a higher rate in this region than anywhere else.
KU performed 114 liver transplants in 2013, according to the Scientific Registry of Transplant Recipients. Only nine other programs nationwide exceeded that number.
The change under consideration aims to make access to donor livers more equitable by shrinking the 11 regions to eight or even four. That way, proponents of the change say, the very sickest patients — many of them on the East and West coasts, where donor rates are comparatively low — won’t have to wait years, as they often do now, for a transplant.
Dr. David Mulligan, a professor of surgery at Yale and chairman of the committee considering the proposal, says equalizing access will give the very sickest patients the same shot at survival as those with better access to livers.
“Patients can wait a little longer and they will be fine and they’re going to have excellent outcomes, and so will the people that have been dying with a chance of getting one who may be in areas that have less robust access to these organs,” Mulligan told KCUR radio recently.
The proposal, however, has roiled many transplant centers, particularly in regions of the country where donor rates are high. If it is adopted, many donor organs from those centers’ regions will be shipped to other regions of the country, leading to longer wait times — and higher mortality rates, according to opponents of the change — for their patients.
Concerned about the effects of the proposal, 45 transplant center physicians and officials last week sent a strongly worded letter to the head of the federal agency that oversees organ donations, the Health Resources Services Administration. The signatories included Richard Gilroy, medical director of liver transplantation at KU, and Jameson Forester, director of abdominal transplantation at St. Luke’s Hospital of Kansas City.
“If this proposal becomes implemented without adequate and constructive improvements it would represent the most drastic change in liver allocation ever and would significantly disadvantage many areas of the country currently able to serve their patient populations,” the letter states.
The letter acknowledges that there is a critical shortage of donor livers in the United States — more than 12,000 patients are listed for liver transplants and only 6,000 transplants are performed annually — but urges further study before any changes are made to the way organs are allocated.
Opponents of the proposal say a better way to reduce the geographical disparities in organ access would be to increase organ donations in areas of the country where donor rates are low.
“Right now, the change in this policy is going to take a lot of livers that would otherwise be available for people here in the Midwest — and Midwesterners are donating them — and take those and go to the East Coast and the West Coast with them,” says Dr. Sean Kumer, a liver transplant surgeon at KU.
That, Kumer says, would merely change “where people die.” Instead, he says, regions with lower donor rates should be encouraged to emulate the KU region, where 82 percent of patients deemed eligible to do so donated organs in 2013.
“So when you look at the population of our area and you compare it to the New York region, for instance, they have 10 times more the population than we have. And their conversion rates are somewhere between 55 and 60 percent,” Kumer says.
The committee considering the organ allocation proposal is holding a public hearing in Chicago on Sept. 16. Kumer says he, along with Gilroy and Dr. Timothy Schmitt, director of transplantation at KU, will be there.
