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New Organ Transplant Rules Help Sickest Patients

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Nov. 16, 2000 (Washington) -- The nation's organ transplant network on Thursday approved sweeping changes to how donor livers would be distributed to thousands of waiting patients, but then refused to propose new rules for breaking down the geographic barriers that presently bar the sharing of these scarce organs across the nation.

In a unanimous vote, the joint Board of Directors for the Organ Procurement and Transplantation Network (OPTN) and United Network for Organ Sharing (UNOS) agreed to adopt a scale that would better measure how sick waiting patients are and then allow donor livers to be distributed to the sickest patients. The scale, which was developed by experts at the Mayo Clinic, is based on objective medical test results, rather than subjective measures assigned by doctors, and strives to eliminate the bias of physicians.

"This is a tremendous step forward in ensuring that ... liver patients with most urgent [medical] needs are met," said Patricia Adams, MD, the president of UNOS, following the vote.

The proposed change will now be submitted to the Department of Health and Human Services (HHS), which signed a contract with UNOS in 1999 allowing the organ transplant network to maintain the nation's organ transplant waiting list. Once the proposed changes are finalized, they will profoundly change how livers are distributed by the nation's organ procurement organizations.

But the proposed change does nothing in terms of breaking down the geographic barriers that currently prevent the sharing of livers across the nation, a change that Congress, patient groups, and HHS have been advocating since 1998.

Under the current system, livers are distributed according to regions: Waiting patients have first crack at the livers in their region despite medical need. Other organs are distributed under a similar system, but about two years ago, that policy came under considerable attack after an Institute of Medicine (IOM) review found that livers could safely be transported across those regional borders because they can be preserved for approximately 24 hours. This finding suggested that sicker patients in other regions should get the donor livers.

A network committee considered several plans for the broader sharing of organs, as requested by HHS, but finally concluded that none of those plans would save a substantial number of lives, explains Richard Freeman, MD, a liver surgeon at Tuffs University who chaired the committee.

"It is possible to transport livers, but as you do that, there is a higher rate of organ failures, higher rate of re-transplants, and a higher rate of deaths after the transplants," he tells WebMD. The IOM review also failed to account for all the patients on the waiting list, analyze the performance of different organ procurement organizations, and address the availability of donors, among other things, Freeman says.

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