A committee on liver transplants said Monday that reducing the nation’s number of transplant regions — from the current 11 to four — could...

A committee on liver transplants said Monday that reducing the nation’s number of transplant regions — from the current 11 to four — could save hundreds of lives.

The United Network for Organ Sharing panel said its aim in the initiative is to reduce the current geographic variation in patient access to transplants.

UNOS is the organization that manages the nation’s organ transplant system under contract with the federal government.

Current liver transplant districts

Its liver committee’s “concept paper,” released Monday, estimates that changing the number of regions to four would lead to a reduction of 581 deaths of people on a liver transplant waiting list.

Having eight regions, another possibility, would cause a reduction of 342 deaths.

But the idea of such a change has already been drawing fire in Georgia. Transplant surgeons here contend that redrawing the districts would hurt the state. Right now, the region that includes Georgia works efficiently in terms of organ donations and distribution, Emory and Piedmont transplant chiefs point out.

Dr. Stuart Knechtle, director of liver transplantation at Emory University Hospital, and chief of transplant services at Children’s Healthcare of Atlanta, told GHN recently that Georgia has a higher disease burden than other states. “We have a poor population and poor access to health care,’’ he said.

In April, a bipartisan group of 11 Georgia congressmen signed a letter to the Health Resources and Services Administration, saying that redistricting “would reduce the number of liver transplants performed in Georgia by 25 percent, reducing access to this lifesaving procedure for Georgians.”

A change would disproportionately harm minorities and poorer patients in Georgia, the letter said.

The liver committee’s paper stated that under the current system, “candidates in some parts of the country must wait until they are very sick before they receive a liver transplant, while those in other parts of the country may receive transplants when they are much less ill.”

Dr. David C. Mulligan, chairman of the UNOS Liver and Intestinal Organ Transplantation Committee, told reporters Monday that an important goal is to reduce deaths of people on a transplant waiting list.

More people are dying on wait lists than ever before, Mulligan said. The geographic disparity in allocations of organs for transplants, he said, “is unacceptably high.”

Mulligan said some people now getting transplants could safely have waited longer. “We want to be fair,’’ he said. “Hundreds of lives are at stake.”

Livers generally are allocated to patients within a local service area, followed by the transplant region. The 11 regions that now exist have wide variations in patients and available organs.

Dr. Mark Johnson, program director of Piedmont Transplant Institute at Piedmont Atlanta Hospital, told GHN recently that other regions have donor rates that are not as strong as Georgia’s.

markjohnson

Dr. Mark Johnson

A remapping to four or eight districts would put Georgia in a region that runs north along the East Coast to Maine.

The current transplantation process is based largely on severity of disease. Because the number of people waiting for new livers far exceeds the number of livers available, a transplant is reserved for a critically ill patient.

The purpose of remapping would be to equalize the MELD scores, a measure of severity of liver disease. That system is a numerical scale used for adult liver transplant candidates. The organs generally go to the sickest patients (by MELD score) within a region.

The median MELD score in Georgia for liver transplants in 2011 was 25 to 28, while in California and a large section of the Northeast, it was 29 or more, the UNOS paper said.

A UNOS spokeswoman said the earliest time any official proposal for a change would go out for public comment would be next spring.

More than 200 Georgians are currently waiting for liver transplants. Emory and Piedmont, along with Children’s Healthcare of Atlanta, perform a total of more than 250 a year.

Under the current set-up, the wait time in Georgia for a liver transplant is less than six months, Piedmont’s Johnson said. And he added that Georgia is now a net exporter of livers, sending 10 to 12 to other states each year.

Piedmont said in a statement Monday about the panel’s report, “We still remain opposed to this redistricting until there is more thoughtful discussion and independent study around the implications of such a drastic change in how livers are allocated.”

“We feel strongly there is a lot of critical information missing from these discussions, which remain centered on short-term outcomes for the sickest of all patients,” the Piedmont statement added.

 


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