Organ-Transplant Network Approves Rules On Liver Recipients

By Laura Meckler

Associated Press

WASHINGTON - The nation's organ-transplant network yesterday approved new rules for distributing scarce livers aimed at making sure the sickest patients are truly at the top of the waiting list.

Network officials say the new system, which uses sophisticated, medical criteria to rank patients, will do a much better job predicting who is most likely to die without a transplant. How long a patient has been waiting, which plays a significant role in ranking patients today, will become much less important.

But the changes endorsed do nothing to break down geographic barriers that keep most organs in the communities where they are donated, even if there is someone sicker in the next city or state over.

The United Network for Organ Sharing endorsed the plan, 32-0, and will now submit it to the Department of Health and Human Services. HHS officials, who have been demanding more sweeping changes, said they were prepared to accept the proposal, at least for now.

While HHS is reviewing the proposal, transplant officials will apply the new standards to current patients to assess the effect of the new rules. But they will not actually be used to distribute livers until HHS gives its approval, which is expected to take several months.

The problem comes down to supply and demand. In 1999, there were 4,698 liver transplants performed, but 1,753 people died waiting. More than 16,000 liver patients are waiting today. Transplant centers also have an interest in maximizing the number of organs that come their way.

Organs are now offered first to patients within a local area, sickest first, and if there are no local matches, to others in the region. If there are no regional matches, the organs are offered to patients in other parts of the county.

A network committee considered 17 plans for sharing livers over broader areas, and a majority concluded that none of them would save a substantial number of lives, said Richard Freeman, a liver surgeon at Tufts University who chaired the committee.

"I really think this whole business of broader sharing is the wrong thing to be focusing on," he said. "It helps some but it disadvantages others. It's so divisive, it's so unproductive, it's so ridiculous. It's a waste of time."

One proposal, he explained, would have saved only about 20 lives per year, which he called a "drop in the bucket."

But broader sharing is what HHS has been pushing since early 1998, when Secretary Donna E. Shalala dramatically declared that patients were dying simply because of where they live.

Now the network is required to submit a new plan for distributing livers, and it has stuck with its initial position against breaking down sometimes arbitrary geographic lines.

This article posted November 23, 2000.

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