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Flawed new policy could see St. Louis patients waiting longer for liver transplants

April 16, 2019

The gift of life can come in a variety of forms, and organ donation is one such gift. There are more than 113,000 people on the organ transplant waiting list and it is unknown when they will receive their lifesaving organ. When Ed from Franklin County got that call, he had been on the waiting list for nearly two years. He and his family were preparing for the worst when a liver became available last October. For Ed, it was just in time. For other Missourians, it may come too late because of misguided changes to our national liver allocation policy.

The board of the Organ Procurement and Transplantation Network (OPTN), the organization responsible for managing the national transplant waiting list and matching donors with recipients, is rushing to change the criteria for allocating livers across the country. The new policy further complicates the already complex and inefficient transplant process and could result in a 32 percent drop in liver transplants in Missouri.

No longer will locally donated livers be more likely to stay in Missouri or other Midwestern states that have high donation rates. Instead, the transplantation network rewards locations that don’t have the high number of organ donors that most Midwestern states do. For example, a state like New York, where 32 percent of people are organ donors, will benefit from the policy change while Missouri, where 73 percent of people are organ donors, will be hurt.

Further, the new policy fails to take into account numerous factors and conditions that must align perfectly for a successful organ transplant, such as the location and viability of the donated organ. In fact, this policy change does not appear to give any weight to locations that have been successful in reducing their waiting lists through assertive organ procurement or by adopting innovative transplant techniques.

Missouri has been a leader in successful donation and transplantation rates despite the inherent challenges involved. The St. Louis region has four transplant centers with some of the best transplantation surgeons and medical experts in the country. In 2017, St. Louis had the fourth-busiest transplant center in the country and our region has been at the forefront of implementing forward-leaning approaches to transplantation to improve patient outcomes.

Yet the transplantation network’s board ignored all of these facts and the recommendation of the Liver and Intestine Transplantation Committee, whose members are some of the nation’s leading transplant experts — including representatives from Missouri. When a similar policy was made for lung transplant allocations, Washington University and Barnes-Jewish Transplant Center experienced a decline in the number of transplants performed locally, with only 30 percent of lungs being from local donors, and the average organ delivery cost more than doubled. Nationally, there was an increase in the number of discarded organs because they were no longer viable. Most strikingly, the new policy for lungs did not change the mortality rate for transplant candidates. The data showed the network’s allocation policy will mean fewer organ transplants in our region, increased inefficiencies and costs, and no real improvement in patient outcomes.

This policy is shortsighted and simply wrong. With 21st-century technology and the expertise of today’s transplantation specialists, the overall number of viable organs for transplant should be increasing and transplant outcomes should continually improve. I’m challenging this unfair action and hope that either the board changes its mind or the courts change it for them.

To read the article online, click here.    

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