A proposal to change the way livers from deceased donors are allocated nationwide got a thumbs down Friday from doctors and those in the transplant community attending a regional meeting in Kansas City of the national organ-sharing network.
After several attendees spoke in strong opposition, the proposed changes were voted down 22-0, with two abstaining.
The vote, which was nonbinding, was taken during the Region 8 business meeting of the United Network for Organ Sharing. The region encompasses Kansas, Missouri, Colorado, Wyoming, Nebraska and Iowa.
“I think this policy proposal is seriously flawed,” said William Chapman, a St. Louis transplant surgeon. “The idea that we have a problem is one that is generally recognized and generally accepted, and I think all in the transplant community want to help fix it. But the significant, vast majority of regions do not think that this is a good idea.”
The proposal calls for collapsing the 11 transplant regions in the country to eight and reallocating donor livers. Supporters call the proposed change a fairness issue and say it’s long overdue. They say it would even out wait times across the country for the sickest patients, whose average waits vary from a few months to more than a year, depending on their geographic region.
Opponents, however, say the proposal raises a multitude of concerns. They say it’s based on a flawed scoring system that doesn’t accurately identify the sickest patients. They also say it could create more harm than benefits and that locally, the wait times would increase and more patients could die while waiting for a transplant. What’s more, they argue, some smaller transplant programs might have to close.
UNOS, which sets the policies that guide how donated organs are matched with transplant candidates, has been taking votes at each of its regional meetings. Since late August, eight regions have voted, and all but two have rejected the proposal.
Stuart Sweet, UNOS president and medical director of the pediatric lung transplant program at St. Louis Children’s Hospital, said the votes are being taken as a way to gauge opinion and garner feedback.
“They are not binding in any way, shape or form,” he said. “This is just a stepping stone. My hope is that the board will review all the information, review all the feedback that the community has provided to us and provide direction to the liver committee about what direction they should go next.”
Sweet said there was still much work to be done.
“We have multiple things that we need to work on as an organization to solve the problem that there’s not enough livers available for transplant,” he said. “Ultimately, our goal is to increase the total number of transplants. ... What we’re trying to accomplish with the modifications is to bring the playing field level across the United States.”
He said a committee would review public comments in a meeting in October and provide a report to the board in December.
“This proposal will not be voted up or down in December,” Sweet said. “This is not an easy issue. It’s very challenging for people to come to a solution. But it’s a solution we have to come to as a community.”
Timothy Schmitt, director of transplantation at the University of Kansas Hospital, said that if the measures are implemented, they will have a major impact on the region.
“This proposal would cause dramatic shifts in organs from rural areas to more densely populated areas,” he said. “Some programs would essentially cease to exist.”
Schmitt said KU performs about 100 liver transplants a year.
“It’s estimated that under this proposal, we would lose about 20 to 30 transplants a year,” he said. “It feels like this is being forced upon us without consensus about what we’re trying to accomplish with this.”