Organ donation inequity fears rise after report

By Annette Wells

Staff Writer

October 3, 2005

Asking potential organ donors to place the little pink dot on a driver's license or tell a loved one to sign away in the emergency room when the time comes has always been a tough sell for the transplant community.

Aside from the fear of discomfort, many worry their liver or heart may go to the rich and famous rather than someone who has a more urgent need for the transplant.

An audit of a 2003 liver transplant at St. Vincent Medical Center in Los Angeles may have snarled efforts made by many to dispel fears and misconceptions about donating organs.

Conducted by the United Network for Organ Sharing, the audit revealed that a Saudi official was moved up the transplant list and received a liver before patients who were in greater need, said Bryan Stewart, director of communications for OneLegacy.

OneLegacy is the federally designated transplant donor network in Southern California. It is the bridge between the tissue and organ donor and the people in need. UNOS is a private group that runs the nation's transplant system.

"It doesn't do much for the transplant community," said John Mitas, a member of the United Organ Transplant Association that meets monthly at Chino Valley Medical Center.

"It kind of undermines what we've been trying to do to get people to donate," Mitas said.

Mitas, a 58-year-old Riverside resident, received a liver transplant at Loma Linda University Medical Center in 2002. When news broke about St. Vincent last week, Mitas was visiting his online transplant support group's Web site.

While online, he received an alert about the incident. His immediate reaction was disbelief.

"I was concerned about how that slipped by OneLegacy," he said. "That's the one thing that had me thinking a little bit."

Stewart said OneLegacy was concerned about that as well but said that is the reason UNOS audits each transplant that occurs in the United States.

The audits are to make sure allocation guidelines and policies are followed.

In lieu of the audit, St. Vincent has voluntarily suspended its liver transplant program, Stewart said.

But some feel people may have a change of heart about organ donation because of the scandal.

Richard Darling, a member of the Coachella Valley Liver Disease Support Group, said the entire organ transplant system should not be judged on this one anomaly.

He said it would be a tragedy for the public to lose confidence, especially to the 85,000 women, men and children in the country awaiting organ transplants.

"Most surgeons don't side-step the rules to get $350,000. Transplant physicians are in this to save lives," said Darling, who also received a liver transplant at Loma Linda.

According to federal statistics, an estimated 70 people receive an organ transplant each day but another 16 die because there are so few available. The shortfall is mostly due to people not wanting to donate.

"We're very, very distressed by this," said Judy Reynolds, executive director of Loma Linda University's Transplantation Institute, which has more than 1,000 people on the national waiting list.

"There is no way to climb the list, unless you're doing what St. Vincent supposedly did," Reynolds said.

Before even getting involved in Loma Linda's transplant program, a patient must be referred by a specialist; a nephrologist for kidney, hepatologist for liver and a cardiologist for heart.

To get on the national transplant list is another marathon. Patients must undergo and meet criteria based on lab tests and evaluations. Then a multidisciplinary committee reviews the results of those tests and evaluations.

OneLegacy and the United Network for Organ Sharing are involved throughout the process. UNOS is the agency that signs off on all patients who make the list, Reynolds said.

Someone needing a liver transplant, for example, would have to meet all of Loma Linda's requirements plus the Model for End-State Liver Disease.

Incepted in the United States in 2002, MELD is a calculation system that ranks patients based on medical need for a liver transplant.

A person's score is the result of three lab tests.

The lab results are typed into a computer and only UNOS determines the MELD score, not the transplant program, hospital or surgeon.

Once a patient is on the list, that score may fluctuate if the patient's health changes, Reynolds said.

"When a liver becomes available, OneLegacy looks on the UNOS list for whoever is the sickest in our local region. Whether or not that patient gets the liver is based upon the person's MELD score and if it's a matching blood type," she said. "If it is, the liver is procured by the center that is going to use the liver. Our surgeons will go out, procure it and bring it back to the hospital."

Other transplants, such as heart and kidney, require different criteria, but medical urgency is at the top of the list, as well as blood and tissue typing, time on waiting list and geographic location.

"To everybody, I would just say this is an unfortunate and unusual situation, and that they should keep the faith in UNOS," he said.

Copyright © 2005 Los Angeles Daily Bulletin.

This article posted October 19, 2005.