Health Care

After three days, liver transplant change put on hold again amid legal wrangling

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 controversial change in the way donor livers are distributed was in place for three days before it was put on hold again Friday amid legal wrangling.

A federal judge in Georgia ruled Tuesday against an injunction filed by a group of hospitals — including the University of Kansas Health System and St. Luke’s Health System — thus allowing the change to go forward. But the hospitals appealed, and on Friday, the judge ruled that the old system must be used until their appeal is heard by a higher court.

U.S. Sen. Roy Blunt, a Missouri Republican who has been a vocal critic of the change, heralded the decision.

“The proposed changes to the liver allocation policy are simply wrong,” Blunt said. “The policy penalizes areas of the country, like ours, that have high donation rates and ignores the recommendations of the nation’s leading transplant experts. It will lead to higher costs and fewer transplants in our region, all while providing no improvement in patient outcomes. I will continue challenging this unfair action and hope the courts will put a permanent stop to it.”

The United Network for Organ Sharing, or UNOS, the nonprofit government contractor that helped develop the new policy, said it will abide by the court ruling and go back to the way it was distributing livers before.

But Anne Paschke, a spokeswoman for the organization, said going back to the former distribution method could take a few weeks.

“Reprogramming this complex and important (computer) system is not a simple process and will take time to execute,” Paschke said Friday. “However, it is underway now, and UNOS will have a greater sense of when the work will be completed next week.”

Paschke said it’s important for patients to know that, amid all the litigation, livers are still being allocated to people on the waiting list.

UNOS has said the change that is now on hold again will save about 100 lives a year by helping ensure the sickest patients get donor livers.

Opponents have questioned whether those projections adequately account for organs that lose viability or surgeries that aren’t successful because of longer transportation times.

Under the former liver distribution policy that UNOS is now moving back to, the sickest patients get first crack at livers donated within their “donor service area.” Kansas City’s area, one of 58 in the nation, includes all of Kansas and most of western Missouri.

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

The proposed change would scrap 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 policy change has been years in the making, with patients and hospitals on both sides fighting to either preserve the status quo or move to the new system. The 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.

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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