Doctors and patients worry about possible liver transplant changes
The federal government has delayed changing the way donor livers are distributed, a proposal that hospitals in Kansas and Missouri said would have led to longer waits — and more deaths — for Midwesterners who need a transplant.
The change was supposed to go into effect at the end of this month but will be put off for at least two weeks as a federal judge in Atlanta weighs a lawsuit brought by more than a dozen transplant centers that believe they stand to lose from the new policy.
The University of Kansas Hospital and St. Luke’s Hospital were among the hospitals that joined the lawsuit this week.
“This is an issue critically important to the patients of our region and we have been very actively involved in this issue for a long time,” KU Hospital transplant surgeon Sean Kumer said in a statement released by the hospital. “We are planning to continue work on this issue to protect our patients’ access to needed transplants closer to home. We are anxiously awaiting the resolution of these liver allocation issues.”
Republican U.S. Sens. Jerry Moran of Kansas and Roy Blunt of Missouri, who have been highly critical of the change, hailed the decision to delay it.
“This delay is good news for Missouri patients who are anxiously waiting for a liver transplant and can’t afford to have these misguided changes move forward,” said Blunt.
Moran said he “will continue working with our strong coalition of policymakers, transplant centers and patient advocates to halt any changes that would negatively impact Kansans and those on transplant wait lists in the Midwest.”
Transplants are a lucrative source of business for hospitals, and regional factions have been arguing for years over how donor livers are distributed. Those arguments started in board rooms of the United Network for Organ Sharing, a federal contractor that advises the government on organ distribution.
They’ve since moved to the halls of Congress and to courtrooms.
The latest change was itself spurred in part by a lawsuit brought by patients in New York and California who said they have to wait longer — and get sicker — than people in other states before they can get a transplant.
But opponents said that’s because those other states tend to have higher organ donation rates and should be rewarded for that. In Kansas, for example, 68% of adults were registered organ donors in 2017. In Missouri the number was 73%. By comparison, in New York it was 32%, and in California it was 47%.
Under the current organ distribution model, the sickest patients within 58 “donor service areas” get first crack at livers that are donated in their area. Kansas City’s area includes all of Kansas and most of western Missouri.
Livers that aren’t claimed are then opened up to one of 11 geographic regions. Kansas City is in Region 8, which is made up of Colorado, Iowa, Kansas, Missouri, Nebraska and Wyoming.
The change that has been delayed scraps that system in favor of a series of concentric circles drawn around the liver donation site. The sickest people within 150 miles get the first shot, followed by the sickest within 250 miles and then the sickest within 500 miles, regardless of state boundaries. In rare cases, critically ill people may even be allowed a chance at a liver from more than 500 miles away.
That means livers that are donated in the Kansas City area might end up being shipped to Chicago, Dallas or the Mayo Clinic in Rochester, Minnesota. But most wouldn’t end up on the coasts, which suffer the most critical shortages.
Anne Paschke, a spokeswoman for the United Network for Organ Sharing, said the group believes the pending change creates a “fairer, more equitable system” that would save about 100 lives each year.
“The reality is that, on average, three people die every day in the U.S. while waiting for a liver transplant, and because this new policy will save more lives by reducing the number of patients who die while waiting, we believe it is an improved policy and a step in the right direction,” Paschke said via email.
Opponents of the policy have disputed the group’s projection of lives saved, saying they believe it underestimates how many more donor livers will be lost and transplants will fail due to longer transit times.
Earlier this year KU Hospital officials testified for a state law seeking to allow Kansas residents to place conditions on the donation of their organs, including, potentially, that recipients must be in state.
Kansas Senate Bill 194 passed a committee vote, but with the legislative session almost over it has yet to get a vote in either the Senate or House of Representatives. Opponents have questioned whether it would stand up in court.