Emory says minorities, poor hurt by proposed changes in liver transplant rules
By David Pendered
Emory University has come out against a proposed change in the national policy governing the distribution of livers for transplant. Emory doctors say could the proposals have a negative impact on minorities and poor folks in Georgia and the southeast in order to benefit folks in the northeast.
“[T]he proposal unfairly disadvantages minorities and lower socioeconomic patients in rural areas in the South by sending those much needed organs to the Northeast,” reads the Emory statement.
Emory is opposing a proposed change in the policy for distributing organs that is offered by the Organ Procurement and Transportation Network and the United Network for Organ Sharing.
The public has a chance to comment in January 2017.
These two entities tend to reside off the radar of most folks, until someone’s organ begins failing and a transplant from a donor arises at the apparent best possible solution.
At this point, patients are introduced to the rules that oversee organ donation and transplant.
According to the agencies involved, some regions of the country don’t have enough organs to meet demand. Other regions have enough organs to meet demand. Here’s how one report from the agency describes the situation:
- “The OPTN/UNOS Board of Directors resolved in November 2012 that existing geographic disparity in organ distribution is “unacceptably high.” It directed the organ-specific committees to define measures of fairness and develop policy to decrease geographic variation.”
The agencies have been striving for years to balance the supply and demand of livers. Here’s one example:
- “As a potential solution, the committee investigated establishing new distribution districts that, unlike the current regional system, create a better balance between the number of liver candidates and donors within various areas of the country. The committee published a concept document in June 2014 outlining its deliberations and seeking public input.”
An array of comments attached to that document speak largely to the notion that affected families want more donors and more solutions to help prolong the lives of their loved ones.
Emory’s statement continues, quoting Dr. Ray Lynch, assistant professor of surgery in the Division of Transplantation at Emory’s School of Medicine:
- “The proposed redistricting will take organs from the South, which already has multiple barriers to liver disease care for minority, low-income, and rural patients, and send them to the Northeast, which has a much higher rate of listing liver disease patients.
- “Shunting organs around the country only satisfies a very narrow definition of resolving a disparity, at the cost of worsening access for populations that are much more broadly recognized as ‘at-risk’ groups.”
Here are the changes that are being proposed:
- “The policy proposal recommends establishing eight liver distribution districts nationwide. As compared to the current 11 regions, these districts would reflect a better balance of organ availability with the number of liver candidates. Candidates in the most urgent medical condition (those with a MELD/PELD score of 29 or higher) would be considered for compatible livers within their district before local matching for less sick candidates. The ultimate goal is to increase consistency across the country in candidates’ medical score at the time of transplantation.
- “Candidates listed at hospitals both inside the district and within 150 miles of the donor’s location would receive three additional allocation points. This would lower the chance that a liver would travel to more distant candidates when a local patient has a similar level of medical urgency.
- “The proposal would not change the current MELD or PELD allocation formulas used to determine the level of medical urgency of liver candidates. It would only address the size of the area where the sickest candidates would first be considered for livers donated in various parts of the country.”