KU Hospital opposes changes to the way transplant livers are distributed
Physicians from Kansas University Hospital are worried about proposed changes that would affect the way transplant livers are distributed in the United States.
A national transplant liver committee recently recommended a reduction in the number of organ sharing districts in the country to lessen the geographic disparity in available livers. KU Hospital physicians, however, say the change would transfer the organs from areas, like the Midwest, that have been successful in encouraging and carrying out liver donations to those that have not.
“The only way to increase the number of liver transplants is to get more donors,” said Dr. Sean Kumer, surgical director of transplantation at KU Hospital. “To shift those livers across the chessboard of the United States is just going to change where people die.”
While roughly 12,000 people are added to the liver transplant waiting list annually, only about 6,000 patients receive a new liver every year. KU Hospital is among the top 10 liver transplant sites in the country, performing 114 in 2013. But people in other parts of the nation, particularly on the East and West coasts, have to be significantly more ill before they can receive a transplant. So the transplant liver committee recommended reducing the number of organ sharing districts from 11 to between four and eight.
But Kumer argues that local donor organizations have simply done a better job of convincing people to donate organs than their counterparts on the coasts. According to Donate Life America, nearly half of adults in Kansas and 69 percent of adults in Missouri are signed up to be organ donors, compared to 22 percent and 37 percent in New York and California, respectively. Kumer also notes that flying livers across the country will not only increase costs but cause worse outcomes because the viability of organs decreases with time.
“We’re supportive of KU’s position because we’re concerned that the current proposal … doesn’t really get at the heart of the problem, which is that we don’t have enough organs for people on the transplant waiting list,” said Rob Linderer, president and CEO of Westwood-based Midwest Transplant Network, the organ-procurement organization for Kansas and western Missouri.
But Dr. David Mulligan, the Yale University surgeon who chairs the transplant liver committee, says the changes would save lives, by delivering organs to patients who need them the most, no matter where in the country they reside. People healthy enough to wait a little longer for a transplant would do just that.
“People shouldn’t be disadvantaged because they happen to live in Los Angeles or San Bernadino or San Francisco or Chicago or New York or Boston or Maine,” he said, noting that there are cultural barriers that prevent people from becoming organ donors in some of those places. “They shouldn’t have to say, ‘Holy cow. I have a chance of dying that is five to six times greater than if I lived in Florida or Louisiana or Kansas or Iowa.'”
Mulligan said that of all the changes the committee looked at, this was the one with the potential to do the greatest good. He estimates the redistricting could save roughly 600 lives and $150 million in federal expenditures on end-stage liver disease.
“It reduced the disparity to less than half of what it is now,” he said. “At the end of the day, more people would be getting transplants across the whole country before they have to get so sick, and everybody wins. That’s really the whole point of this discussion.”
But Dennis McCulloch, a spokesman for KU Hospital, said the changes would “turn the Midwest into an organ farm.” He added that those awaiting transplants at KU Hospital would be punished because its doctors have been so effective.
“Our current team of transplant surgeons has learned to be innovative and find ways to use the livers that are offered to them, in terms of their ability to use a less-than-optimal liver and still make a successful transplant,” he said. “It’s not only volume; it’s outcomes that they’re leaders in.”
Keith Anderson, executive director of Overland Park-based Gift of Life, which tries to persuade area high schoolers to become organ donors, argued that Midwesterners aren’t necessarily more giving than people on the coasts but better educated about organ donation.
“We call it ‘informed generosity,'” he said. “If you told me my organs can save the lives of eight people and my tissues can enhance 50 lives, I’d say, ‘You know what. Donate my organs.’ It makes a difference.”
The proposed changes will be discussed at a public forum Sept. 16 in Chicago. Several KU transplant doctors plan to be there.