Fast track to a transplant

Reformer Staff

WESTMINSTER -- When Scott Fitts' doctor told him that he had advanced cirrhosis of the liver, he prepared himself for a long wait on a donor list.

Fitts, 42, also understood that the recovery could take months, and he started looking into the myriad of insurance forms he would need to fill out.

But Fitts never thought he would need to go to Indiana.

Yet that is exactly where he hopes to head next month to await an organ transplant.

After his doctor's diagnosis, Fitts put himself on a waiting list at a Boston hospital. Administrators there told him he would probably need to wait up to 18 months, which is too long to wait considering his doctor said he should have died already due to the state of his liver.

Dr. Jeff Potash, a Brattleboro gastroenterologist who was treating Fitts, told him to try and call the Clarian Transplant Center at Indiana University Hospital. Fitts called the Midwestern medical center.

"I called and they asked my height and weight, blood type and MELD score," Fitts said earlier this week, sitting in his easy chair at his home off Route 121. "A day later we got a call and they wanted us there on June 16. I didn't think we could make that, so they said to come on June 23 and I thought, we better take that."

Livers in this country are in tight supply, and they are doled out under a complex system called a Mayo End-Stage Liver Disease, or MELD, score. The MELD score measures the overall health of the person who needs a new liver, and across the country the people with the highest MELD score, or those who are sickest, get the organ once it becomes available.

The problem with this, experts involved with organ transplants say, is that those people are often in advanced stages of disease and their kidneys are starting to fail as well.

"It is kind of tragic," said Bob Madison, spokesman for the American Liver Foundation. "Sometimes those people with a high MELD score are so sick that it turns out to be a wasted transplant. We are looking to improve the selection process."

"The idea behind the MELD score is to try and help people before they fall off the ledge, but the fact is that the very people it is supposed to help end up being failed by the system. It is a hard thing to get our hands around," said Catherine Paykin, transplant programs director for the National Kidney Foundation.

All transplant organs -- be they livers, kidneys or hearts -- must go through a national registry at the United Network for Organ Sharing. UNOS is a private contractor that works with the federal government to collect and manage transplant data and help match and place organs with patients.

Around 85,000 people across the country are waiting for organs, according to the UNOS Web site.

"It is a work in progress and we are learning as we go," Paykin said.

Dr. Potash said that a patient of his searched out the Indiana facility and he has been sending his very sickest clients there. The chief surgeon in Indiana, Dr. Joe Tector, is known for "pushing the boundaries" of transplant surgery, Potash said. Tector will accept livers from older donors which other surgeons might refuse, according to Potash.

"Dr. Tector is dear to my heart, and dear to my liver," said Paula Fielding, a Marlboro resident and patient of Dr. Potash who received a transplant in Indiana.

Fielding said the waiting list in Indiana is short because Tector's aggressive actions have whittled away at the MELD scores. While at other hospitals, transplant patients are usually in the 30 to 35 range, at his hospital they have gotten into the 20s.

"If I needed to wait in Boston, I would have died," Fielding said.

James Wide, Clarian Transplant Center spokesman, said the 2001 Indiana Donor Choice Law helped increase the availability of organs in the region. The law does not allow families to change the wish of those recently deceased if they have signed organ donor cards. He said the law has helped lower the wait time for transplant surgery.

He also said surgeons go out and look at organs that other centers might refuse.

Scott Fitts and his wife Rhonda are preparing to head out to Indiana. Insurance will cover the surgery, but they must come up with two months worth of living expenses. They could expect a month's wait before the operation, and a month of recovery.

An account at the River Valley Credit Union has been set up for those seeking to contribute to their journey.

This article posted July 25, 2004.

Fast track to a transplant

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