Wednesday, 16 Jan 2019
News

Critics say new transplant rules will benefit medical centers in major cities


The organization that controls the distribution of the liver for transplantation revised its controversial attribution policy for the second time in a year, further limiting access of transplant centers to organs harvested in their area. The new plan removes the geographic boundaries that were laid out many years ago and largely gave the transplant centers the first shots of liver from donors with brain death in nearby hospitals. It moves the liver transplant system further to a "sickest first" model that would send organs to recipients far more than 500 km away if they demonstrate the greatest need. Critics said the new plan will inevitably transfer livers from low-income, rural South, Midwestern and Northwest regions to transplant centers in major New York, Boston, Houston, Minneapolis, and other cities. places where the population is larger and the demand without respite. "It's a disaster," said Raymond J. Lynch, a liver transplant surgeon and assistant professor of surgery at Emory University's School of Medicine in Atlanta, which serves rural populations in the southeast. "We should not fool ourselves. When you move a liver, you move a death. The United States faces a serious shortage of livers, kidneys, hearts, lungs and other organs to transplant. Nearly 115,000 people are on waiting lists for these organs and at least 20 die waiting each day. In 2017, 13,583 people were on the list of livers, but only 7,715 transplants were performed. Four or five people waiting for a liver die each day. This makes each available organ expensive and highly coveted. Transplant managers, hospitals, government and non-profit organizations that collect organs have been working for decades to find ways to make the system more equitable and to increase the number of available organs.
Wayne Cooper is recovering at home from a liver transplant performed in 2017 by his daughter, Patricia Cooper. (Salwan Georges / The Washington Post) Last December, Transplant network officials voted in favor of abandoning established borders around transplant hospitals, which dictated where the liver would be offered first. But the new plan did not satisfy a group of patients who said they wait longer than people in other less sick areas of the country. They lodged a complaint in New York in July, urging the government to order the transplant network to reconsider its decision. Motty Shulman, the lawyer for these patients, called Monday's vote "a giant step" and said it "would benefit the more than 13,000 people currently on the waiting list for the liver and thousands of others in the years to come. Monday's decision from 30 to 7 out of 7 the transplant network board will establish a system that will give top priority to a handful of people living within 500 nautical miles of the donor's hospital and who are so seriously ill that their liver need is considered an emergency. After that, he offers livers to the sickest patients within a radius of 150, 250 and 500 nautical miles, in that order. The severity of the disease is based on a score calculated with the help of blood tests indicating how far the disease has progressed. A spokesman for the network said that under the new plan, the livers would receive a median distance of less than 200 nautical miles, compared to 80 at present, which would allow many to stay on the spot. However, Lynch said that poor and rural residents have less access to care than people living in big cities, so they are less likely to be diagnosed with liver disease and get a place on the health care list. 'waiting. According to him, the statistical modeling shows that transplant centers in the Greater New York area will gain more than 100 livers a year thanks to the current system, which will force places that lose organs to take them in places like Tennessee, Michigan, Georgia, Alabama and Louisiana. According to him and others, one of the main problems is that New York's "organ harvesting agency" is among the worst in the country in terms of organ harvesting for transplant centers in his area. . For the first time in 19 years, the government announced in June that it would end the contract of this nonprofit agency, LiveOnNY, because of its poor performance. Learn more Who deserves a liver? Officials try to make transplant system more equitable Liver transplant policy has changed after decades of debate People with autism and intellectual disabilities battle prejudices during organ transplantation.

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