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schmitt-timothy-BWP0008P“This proposal will have a dramatic (negative) impact on patients in our area, including rural populations and veterans... It’s a proposal that benefits large urban areas like New York and California where organ donation rates are lower.” 

- Dr. Timothy Schmitt, MD 
Director, Center for Transplantation

Say No to Liver Allocation Changes

The United Network for Organ Sharing (UNOS), the organization charged with managing organ transplantation, has recently submitted a proposal for public comment which would change the way livers are allocated for transplant.

This new UNOS proposal for liver reallocation:

  • Focuses on an arbitrary goal of equalizing MELD score (a measure of patient severity) nationwide
  • Calls for converting the current 11 geographical organ donation regions to eight, and creates a region-wide organ sharing at a patient MELD score of 29
  • Does not address differences in listing practices, wait list mortality or access to care in rural areas
  • Will have a dramatic impact on patients in our area, including rural populations and veterans, the  Midwest, South and Northwest 
  • Will benefit large urban areas like New York and California, where organ donation rates are lower than the Midwest and South 

Learn more about the concerns surrounding changes in donor liver allocation.

Please help us turn the focus toward donation and increasing the opportunity for a lifesaving transplant

The University of Kansas Hospital is against this plan for a number of reasons. 

  • liver allocationFewer total transplants
    The proposal is estimated to decrease the number of liver transplants by 2 percent nationwide, an estimated decrease by our own calculations of 20-30 percent of our current volume. We find it troubling UNOS has refused to estimate volume changes for individual programs.
  • Organ donation not included in proposal
    • The proposal does not address increasing donation, which is the real challenge facing the transplant community.
    • The proposal ignores the fact the only way to increase the number of transplants is to increase the number of donors.
  • Conflict of interest
    • A conflict of interest exists for the developers of the plan. The developers received a $3 million contract from the Health Resources and Services Administration (HRSA) to develop a plan, which in turn benefits the hospital where the recipients work. The hospital where the plan developers work will see an increase in the number of liver transplants performed and potential increase in revenue. UNOS fails to acknowledge this conflict of interest.
    • The Liver and Intestine Transplantation Committee, which considers policies such as the one presented, includes a significant number of members who will see an increase in the number of transplants and subsequently an increase in revenue based on this proposal. The current and past chairs of the program who pushed forward with this proposal continue to advance it — despite two public transplant forum meetings which demonstrated a strong majority against the proposed idea.
  • Logistics concerns and increased cost of transport
    The proposal also fails to address the complexity of broader sharing from a logistics and cost of transportation standpoint. The developers of the proposal admit the proposal will:
    • Increase transport time by up to 11 percent.
    • Increase transportation distance by up to 87 percent from a median of 124 miles up to 232 miles.
    • Increase the number of livers that would need to be flown by chartered aircraft by 13 percent (the proposal states that up to 73.1 percent of livers could be flown).
    • Increase the cost to hospital transplant centers and organ procurement organizations due to additional and extended transportation requirements of the new proposal,
    • Increase the number of healthy livers being flown to other areas due to their ability to survive travel leaving less healthy livers to be allocated locally among those patients on the waiting list.
  • Fails to address outcomes, waitlist mortality and access to care within both rural areas and the Veteran’s Administration system
  • Most importantly, the proposal portrays livers as a commodity
    Livers come from human beings. It is the gift of donation by people, by families, which is the foundation of this system. 

UNOS needs to shift the focus away from policies which increase costs for patients and the system overall, as well as decrease the number of transplants performed and instead, focus on donation education and awareness which will in turn increase the number of livers available for transplant. 

Education, grassroots and legislative efforts along with overall community awareness will help increase organ donation, and help people on all transplant lists.