Currently, the U.S. is divided into 11 organ-sharing regions.(Photo: Getty Images/iStockphoto)
The nation’s top transplant surgeons met three weeks ago in Chicago.
They didn’t talk medicine. They argued logistics.
The issue is a controversial plan to address geographic disparities in liver transplants that would shorten wait times in some areas of the country at the expense of others. This committee of the United Network for Organ Sharing has debated for a year the redistricting proposal — one that Vanderbilt University Medical Center opposes.
Dr. Seth Karp, director of the Vanderbilt Transplant Center, is a member of that committee, and he’s worried. The committee punted making a decision on June 23, but one is coming. Karp said the changes are projected to shift a substantial number of organs from the South to the Northeast and could decrease the availability of livers in Tennessee by about 30 percent.
“At the end of the day, this is rearranging deck chairs; it is not saving lives,” Karp said.
Currently, the U.S. is divided into 11 organ-sharing regions. The proposals are to reduce the number to eight or four districts. Another proposal introduced at the June meeting is to develop a concentric circle sharing system using the 11 existing districts.
A concept paper on redistricting estimated that having four districts would save 554 additional lives nationwide over a five-year period, and having eight districts would save 332 lives over the same time frame. However, Karp said these estimates are based on MELD scores — a numerical system that determines who is in most need of a liver transplant — and wait times. He said that’s not the best measure for comparing disparity, noting that the South has a higher incidence of waiting list mortality.
“Places like New York have very low waiting list mortality,” Karp said. “So you are taking livers from places that have a higher waiting list mortality and you’re sending them to places that have lower waiting list mortality. That doesn’t make a lot of sense to me.”
People in New York are not as willing to sign up to be organ donors as Tennesseans are.
New York, which has a population of 19.7 million people, has had 88 liver donations from deceased individuals in that state so far this year, according to federal data. Tennessee, which has a population of 6.5 million people, has had 80 donations.
The state of New York had the lowest donation consent rate in the nation, according to research published this year in the American Journal of Transplantation.
“It’s almost like rewarding bad performance,” Karp said.
Greater New York Hospital Association and other partners, including a Los Angeles-based organ procurement organization, launched in May the Coalition for Organ Distribution Equity. The organization sent representatives to the UNOS committee meeting three weeks ago to advocate for new districts.
About 200 people attended that meeting, while another 210 participated through a webinar, said Dr. David Mulligan, the chairman of the UNOS Liver and Intestinal Organ Transplantation Committee.
“Based on your ideas and questions, our committee unanimously resolved both to consider additional results in modeling of concepts previously developed and to further analyze an additional concept,” Mulligan said in a message to participants. “We expect to have these new analyses available over the next few months to share again with you and guide our policy development.”
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