UNOS Expected to Propose New Sickest-First Distribution Plan for Livers

The United Network for Organ Sharing is expected on Nov. 16 to approve a new plan for liver allocation that will ensure that the "sickest patients are truly at the top of the waiting list" for transplants, the AP/Conta Costa Times reports. The proposal being considered by UNOS would "create a more precise scale" for assessing the severity of patients' illnesses so that livers can be given to the neediest patients. Under current policy, patients are divided into four categories, with the length of time on the waiting list determining who receives the next available liver in each group. The new policy would still grant priority to Status 1 patients, or those who are expected to die within a week without a transplant, but would assign a number to all other patients, with the sickest patients receiving the highest number. Severity of illness would be determined by the Mayo Clinic's End-stage Liver Disease system, which examines medical factors such as coagulation ability, hemoglobin decomposition ability and kidney function. Critics of the new allocation plan argue that it does not break down current geographic barriers that keep most donated organs in the communities where they are donated. HHS and UNOS have been arguing over organ allocation for two years, since HHS Secretary Donna Shalala issued regulations directing broader geographic sharing of organs to treat the sickest patients first. Faced with competition for the job of distributing donated organs, UNOS finally agreed to a new contract that "spelled out every detail of the regulation." Although the new plan does significantly change the ranking of waiting patients, Craig Irwin of the National Transplant Action Committee said the UNOS proposal is still "skirting around the issue of distribution." Last year, 4,698 liver transplants were performed, but 1,753 patients died while waiting for a liver. Currently, over 16,000 patients are on the liver transplant waiting list. A UNOS committee reviewed 17 plans for sharing livers over broader areas but concluded that none would "save a substantial number of lives." Committee chair and Tufts University liver surgeon Dr. Richard Freeman said, "I really think this business of broader sharing is the wrong thing to be focusing on. It helps some but it disadvantages others" (Meckler, AP/Contra Costa Times, 11/15). Irwin sent a letter to the UNOS board of directors, which meets this week in Washington, D.C., calling on the organization to "reform its liver allocation system," and "comply with the mandates of HHS's Final Rule." He said, "Failure to do so could put the organization's future at risk as well as the future of the Organ Procurement and Transplantation Network. We do not believe that this would be in the best interest of the more than 70,000 individuals currently waiting for organ transplants in the United States" (National Transplant Action Committee release, 11/15). UNOS must submit its new proposal to HHS for approval, which it is likely to receive "at least for now." HHS officials said they will "wait to see how the new severity scale functions before demanding that the network reconsider the issue of geographic boundaries" (AP/Contra Costa Times, 11/15).