Vanderbilt doctors: Liver transplant policy change will lead to more Tennesseans dying on wait list

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Posted at 4:08 AM, Feb 21, 2020
and last updated 2020-02-21 07:48:51-05

NASHVILLE, Tenn. (WTVF) — A change in the way donated livers are distributed throughout the country will lead to more Tennesseans dying on the transplant wait list, according to Vanderbilt University Medical Center.

NewsChannel 5 has been following this story for almost a year since a federal judge temporarily halted the implementation of a policy that changed how donated livers are distributed. This came after VUMC and 13 other liver transplant centers filed a lawsuit against the acuity circles policy in April 2018. It's the new policy that allows livers to travel hundreds of miles further away to the highest priority patients.

The temporary halt on the policy change lifted February 4. The United Network for Organ Sharing (UNOS), the nonprofit organization that runs the transplant system, says the new policy will save more lives. VUMC is worried it will be the reason their patients will die waiting for a liver.

Robin Majors developed liver cancer six years ago. He was number 22 on the list for a transplant. He expected to wait for months.

"You're anxious already thinking, dang, this is the only thing that’s going to keep me alive," Majors said.

Then, he got the phone call that saved his life.

"I made the list January 15 of 2014." Majors said. "Thirteen days later, I got the phone call, so, pretty amazing. It all happened that fast.

Today, there's a good chance it would have taken much longer because of the recent liver distribution policy change. That's a big concern for Dr. Seth Karp, the director of the transplant center at VUMC,

"Perhaps two or three times the number of patients that are dying on the waiting list will now die in Tennessee waiting on the waiting list instead of getting a liver transplant," Karp said.

According to Karp, a lot of Tennesseans donate organs -- roughly three times as many as a state like New York.

"Before it was basically the community was responsible for its own donation. So, if Tennessee wanted to have more donors to do more transplants to save more lives of people in Tennessee, they would have to do better with donation," Karp said, "and if New York wanted to have more donors, then have more transplants, then they would need to get more donors."

He says the solution isn't to take from rural states with worse healthcare to benefit wealthier, urban states, but instead to encourage more people to become organ donors.

"If New York...and other urban centers could get to the same donation levels that we have here in Tennessee, there would not be an organ shortage for livers, lungs or hearts," Karp said. "That's an extraordinary statement."

For the man who's life was saved because of an organ donor, Majors agrees.

"Sign your donor card," Majors said. "The only way these doctors are going to help people are to get out there and sign your donor card and I'd appreciate it if you do."

In a statement, UNOS said:

"The goal of the new liver distribution policy that went into effect on Feb. 4 is to get livers to the sickest patients first in order to save as many lives as possible. Statistical modeling of the new policy projects that it will save more lives, with fewer patients dying while waiting for a liver transplant. It also makes the system fairer by providing more equitable access to a transplant based on medical need for the benefit of all patients. The policy also is expected to increase the number of liver transplants for children under the age of 18 by increasing their priority for organs from donors who are also younger than 18. The benefits of the system are projected to have similar effects across various socioeconomic groups and population types, such as urban, rural and suburban."

When asked what they would do if the liver transplant centers won the lawsuit they filed, UNOS responded:

"The lawsuit questions the process used to approve the policy, not the policy itself, and the District Court and 11th Circuit Court of Appeals have already found that the correct process was followed. If the courts eventually rule that the appropriate process wasn’t followed, we would work to implement an appropriate process to re-approve the acuity circles liver allocation policy as soon as possible."

In response, VUMC general counsel Mike Regier said in a statement:

“Although the Court has declined to temporarily stop implementation of the acuity circles policy pending trial, the Court has not finally determined that the appropriate process was followed. That— among other things— is yet to be decided. At a minimum, we believe this policy should have been published in the Federal register for public comment. Should that be required by the Court, HHS and UNOS as its contractor would be required to give good faith consideration to the public comments made, to respond to them and to consider incorporating them in the proposed policy. For UNOS as the contractor to HHS to say that at this stage that it would simply adopt the same policy without change, regardless of the number or nature of comments received, is a complete abdication of HHS and UNOS’s responsibility to the public and—more importantly— to the thousands of transplant patients who are being harmed by the decreases in organ availability that this unwarranted policy change is causing.”