The organization that controls the distribution of livers for transplant revised its controversial allocation policy for the second time in a year, further limiting transplant centers' access to organs collected in their areas.
The new plan eliminates geographical boundaries drawn years ago that had largely given transplant centers first shot at livers collected from brain-dead donors in hospitals nearby. It moves the liver transplant system further toward a "sickest-first" model that would send organs to recipients more than 500 miles away if they demonstrate the greatest need.
Critics said the new plan will inevitably transfer livers from rural and low-income parts of the South, Midwest and Northwest to big city transplant centers in New York, Boston, Houston, Minneapolis and other locations where populations are larger and demand is relentless.
"This is a disaster," said Raymond 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 kid ourselves. When you move a liver, you move a death."
The United States faces a severe shortage of livers, kidneys, hearts, lungs and other organs for transplant. Nearly 115,000 people are on waiting lists for those organs, and at least 20 die waiting each day. In 2017, 13,583 people were on the list for livers, but just 7,715 transplants were performed. Four or five people waiting for livers die each day.
That makes every available organ expensive and highly coveted. Transplant officials, hospitals, the government and the nonprofits that collect organs have grappled for decades with ways to make the system fairer and increase available organs.
Last December, transplant network leaders voted to move away from the long-standing boundaries around transplant hospitals that dictated where livers would be offered first.
But the new plan did not satisfy a group of patients who said they were waiting longer than people in other parts of the country who were less ill. They filed a lawsuit in New York in July, prompting the government to order the transplant network to reconsider.
Motty Shulman, an attorney for those patients, called Monday's vote "a giant step" and said it would "benefit the over 13,000 individuals currently on the liver waitlist and thousands more in the years to come."
Monday's 30-to-7 decision by the transplant network board will establish a system that gives top priority to a handful of people who live within 500 nautical miles of the donor's hospital and are so critically ill that their need for a liver is considered an emergency. After that, it offers livers to the sickest patients within 150, 250 and 500 nautical miles, in that order. Severity of illness is based on a score calculated via blood tests that show how far the disease has progressed.
A spokesman for the network said that under the new plan, livers would be sent a median distance of less than 200 nautical miles, up from about 80 currently, allowing for many to stay local.
However, Lynch said poor and rural residents have less access to care than people in large cities and therefore less chance of being diagnosed with liver disease and gaining a spot on the waiting list. He said statistical modeling shows that transplant centers in metropolitan New York will gain more than 100 livers annually over the current system, forcing places that lose organs to take them, in turn, from places like Tennessee, Michigan, Georgia, Alabama and Louisiana.
A main issue, he and others have said, is that New York’s “organ procurement agency” is among the worst in the country at collecting organs for transplant centers in its area. For the first time in 19 years, the government announced in June that it would terminate the contract of that nonprofit agency, LiveOnNY, citing poor performance.