The distribution of liver transplant changed after years of debate


After years of debate, the organization that oversees the allocation of livers for transplant took action on Monday to address a long-standing geographic disparity in the supply of scarce organs.

The policy approved by the Organ Acquisition and Transplantation Network will make more livers available in some places, including cities such as New York and Los Angeles, where the shortage is more serious than it is in regions such as the southeastern United States. .

"The essential thing to emphasize about this proposal is that we do move things in the direction we want to go, throughout the country," said Julie Heimbach, chairwoman of the committee that developed the proposal after considering 63 alternatives in more than five Years of debate often heated.

Many speakers described the approach on Monday as a commitment that most could adopt, but very few satisfied.

David S. Goldberg, a hepatologist at Perel University of Pennsylvania The man from the School of Medicine who has studied liver disparity said in an email that he is concerned about the policy because he does not consider liver donation rates , which vary drastically throughout the country.

The United Network for Organ Sharing (UNOS) regional map showing how the country is currently divided into regions for liver distribution. (United Network for Organ Sharing)

But, Goldberg said, "in the spirit of commitment and maintaining the value of debate and democratic discussion within our transplant community and the general public, I can support this proposal."

Geographic disparity in the available livers has plagued transplant patients for decades. The United Network for Organ Sharing, the nonprofit organization that coordinates organ transplantation, divides the country into 11 regions for liver distribution.

In Region 9, for example, which includes New York, only 327 livers were donated in 2016, continuing a pattern of meager purchases dating back decades. In Region 3, which includes the deep south and Puerto Rico, 1,336 livers were obtained from deceased donors.

That's partly because the deep south is the center of the nation's "stroke belt," where the highest rates of obesity, pressure and diabetes cause fatal strokes, leaving more donors with intact livers . Many southern states also have higher than average traffic accident mortality rates.

In general, however, there are very few livers available for people who need them. Last year, 7,841 deceased donor liver were transplanted in the United States, while another 14,000 remained on the national waiting list. More than a thousand people die on the waiting list every year.

Since 2002, people have been placed on waiting lists in the 143 liver transplant centers in the country based on a score derived from blood tests that indicate the progress of their disease. The higher the score, the sicker the patient will be.

Using the scores, an organ is first offered within the local district and the region where it was donated, before it can be distributed to other regions if there is no match between the donor and the recipient. People with resources can register at multiple transplant centers, which is how the late Apple founder Steve Jobs, who lived in California, received a liver in Tennessee.

The new complex plan would expand the area in which an organ can be offered by drawing a circle of 150 nautical miles around the donor hospitals, although some exceptions would apply. It is expected that there are hundreds of livers more available for patients in areas where patients wait longer.

Pending the vote was a lawsuit made Friday by a seriously ill patient at Mount Sinai Medical Center in New York, who said the board should abandon its policy of offering first organs within each of the 58 districts where Livers are acquired, known as "donor service areas".

A lawyer for Tamiany de la Rosa, 25, said in a letter to Eric D. Hargan, interim secretary of the US Department of Health and Human Services. UU., That the arbitrary geographical limits violate the law, which emphasizes giving first livers to the sickest patients.

Last month, a judge's order in a lawsuit in New York triggered an emergency policy change that reduced the importance of geographical divisions in allocating lungs for transplant.

According to the plan approved on Monday, the state of New York would become a very large district for the purpose of distribution of livers.

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