Health Care

KU, St. Luke’s and other hospitals appeal as judge allows change to transplant rules

Doctors and patients worry about possible liver transplant changes

Proposed changes to liver allocation rules could take some donor livers away from the Kansas City area.
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Proposed changes to liver allocation rules could take some donor livers away from the Kansas City area.

A new way of distributing donor livers took effect Tuesday, over the objections of medical centers mostly in the Midwest who say it will mean more livers heading to patients on the coasts.

The University of Kansas Hospital and St. Luke’s Hospital were among more than a dozen plaintiffs who had filed suit in a federal court in Georgia to try to stop the change, which has been months in the works. After the judge, Amy Totenberg, denied their request for an injunction Tuesday, they immediately said they would appeal.

“In the meantime, we have asked the Atlanta court to enjoin the policy’s implementation pending appeal to ensure that the difficult factual and legal questions at play are given adequate consideration, so that the many Americans whose lives depend on a liver transplant are treated fairly under the law,” the plaintiffs said in a joint statement.

A spokeswoman for United Network for Organ Sharing, or UNOS, the nonprofit government contractor that helped develop the new policy, called the decision a “long-awaited relief to seriously ill patients awaiting a life-saving liver transplant.”

“This has been a challenging time as the transplant community has been divided on the new liver policy,” the spokeswoman, Anne Paschke, said. “Regardless of the ultimate outcome of the legal proceedings, UNOS will strive to reunite all parties and focus on what at our core unifies us — the vital work of saving lives. We will work with the community in a transparent process to evaluate the policy and determine if it is having the intended effect.”

Paschke acknowledged the plaintiffs’ intent to appeal, saying she hoped it would be a speedy process that allows everyone to move forward. She confirmed that the policy change would go into effect Tuesday, as scheduled.

Paschke said the new policy is projected to save 100 lives a year by distributing organs to people who need them the most, even if they may live farther from the donation site than others.

Plaintiffs question whether those projections adequately account for organs that lose viability or surgeries that aren’t successful because of longer transportation times. U.S. Sens. Roy Blunt of Missouri and Jerry Moran of Kansas have also been strongly critical of the change and have urged the U.S. Department of Health and Human Services to reconsider.

Under the previous policy, the sickest patients got first crack at livers donated within their “donor service area.” Kansas City’s area, one of 58 in the nation, included all of Kansas and most of western Missouri.

Livers that weren’t claimed in those areas were then opened up to one of 11 larger geographic regions. Kansas City was in Region 8, which is made up of Colorado, Iowa, Kansas, Missouri, Nebraska and Wyoming.

The change scraps that system in favor of a series of concentric circles drawn around the liver donation site, regardless of state boundaries. The sickest people within 150 miles get the first shot, followed by the sickest within 250 miles and then the sickest within 500 miles. 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.

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%.

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Kansas City Star health reporter Andy Marso was part of a Pulitzer Prize-finalist team at The Star and previously won state and regional awards at the Topeka Capital-Journal and Kansas Health Institute News Service. He has written two books, including one about his near-fatal bout with meningitis.

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