U.S. to Require Liver Transplant Priority by Need, Not Location

The nation’s transplant program must offer donated livers to the sickest patients first, the government said Thursday, promising to overthrow a system that gives priority to patients who live closest to the donor.

The action caps a nasty political fight that has dragged on for more than three years as the Health and Human Services Department debated rules governing the transplant program. The dilemma is how to distribute 4,000 livers each year among 7,000 waiting patients.

On one side is the United Network for Organ Sharing, which runs the transplant program and established the current policies. The network is controlled by transplant centers, most of which benefit from the policy that assures small programs will be offered organs donated locally.

On the other side are relatively few larger centers that care for the sickest patients and have the largest number of people waiting. Led by the University of Pittsburgh, a giant in the liver transplant field, they have lobbied for a system based on medical need.

HHS still has not issued rules governing the transplant network, but it released a letter Thursday saying it will require that the organ network put patients with the greatest medical need “at the head of the list.”

“We can assure Americans that organ allocation policies are equitable and that those who need organ transplants will be treated according to medical need, no matter where in the country they may be hospitalized,” HHS Secretary Donna Shalala said in a six-page letter to members of Congress.

The waiting time for livers is five times as long in some parts of the country as in others.

Joel Newman, spokesman for the organ network, did not defend the substance of the current program but said it was created by a consensus of transplant professionals.

Patients and advocates on Thursday demonstrated outside HHS, prodding Shalala to issue the formal rules.

The rules will be issued “as soon as possible,” HHS spokesman Campbell Gardett said.

They will affect all organs, but livers have been the only ones to engender fierce debate.