Donor livers may not go to the most needy
-------------------- BY KATHLEEN KERR                April 21, 2004

Precious donor livers don't always go to patients who need them most and more should be done to improve the fairness of the country's transplant system, a new study has found.

The problem begins in areas where federally designated organizations that procure and distribute donor organs have small waiting lists of patients needing livers, researchers at the University of Colorado Health Sciences Center found.

Those organizations tend to give livers to people within the areas they cover, even if they are not as sick as patients elsewhere, the researchers found in a study published in this week's issue of the Journal of the American Medical Association.

"In a small city, if a donor liver becomes available, it will go to a patient listed there," said Dr. James Trotter, the study's lead author.

Trotter said enlarging the population covered by each organ procurement organization - there are 59 nationwide - could help resolve the problem. The larger the coverage area, the greater the likelihood of identifying extremely ill patients in need of a liver and preventing scarce organs from going to those with more time to wait.

Arthur Caplan, the director of the bioethics center at the University of Pennsylvania and an organ transplant expert, agrees with Trotter's findings.

"The idea of keeping organs local doesn't make sense," Caplan said. "I don't think when families donate a loved one's organ they think, 'Gosh, I hope this goes to someone in Nassau County.'"

Trotter said New York State's system works well. New York has four organ procurement groups - including the Manhattan-based New York Organ Donor Network, which covers New York City and Long Island - and they share livers according to patient needs.

In June, the United Network for Organ Sharing - a nationwide organization of all the procurement groups - will consider a proposal to improve the liver distribution system. Under the proposal, patients found to be desperately in need of a transplant according to a special scoring system will receive livers as they become available within their own areas. Patients who score lower will be temporarily bypassed because they are not as sick. And if there are no high-scoring patients in a procurement area, livers will be made available regionally.

"We need to get the livers to the patients with the highest MELD [Model for Endstage Liver Disease] score, that have the highest risk of dying," said Dr. Russell Wiesner, chairman of the board of the United Network and medical director of viral hepatitis at the Mayo Clinic.

In 2003, 379 people in New York received liver transplants from deceased donors. As of April 16, 2,183 patients in the state awaited transplants.

Copyright (c) 2004, Newsday, Inc.