Acutely ill patients soon will have first shot at livers donated for transplantation under new rules that have stirred public confusion, according to the architects of those regulations.
Last month, the United Network for Organ Sharing, a Richmond, Va.-based organization that coordinates organ matches and develops transplant policy under a federal contract, adopted guidelines that reclassify patients awaiting liver transplants.
The new policy, set to take effect next month, moves patients whose livers have recently failed ahead of patients with chronic diseases that have not completely sapped their livers' ability to detoxify blood (Nov. 11, p. 4).
That change sparked concern among many patients about possible discrimination against the chronically ill based in part on the cause of their disease.
According to some in the organ transplant community, early press reports about the changes implied that livers would be denied to patients whose illness stemmed from alcoholism, causing widespread alarm.
"Our transplant centers were flooded with calls from patients" worried about the change, said Howard Nathan, executive director of Delaware Valley Transplant Program, which this year will supply nearly 225 livers for transplantation.
But UNOS has moved quickly to try to dispel those suspicions.
"There was never any explicit treatment of the types of liver disease" in developing the new policy, said James Burdick, a transplant surgeon at Johns Hopkins Medical Center and president of UNOS' board of directors. "The changes had nothing to do with etiology."
Instead, the modifications were made to maximize the chances that donated livers could be used to save patients in acute distress.
The new guidelines are expected to increase total liver transplantations by 200 over the next three years to 11,914, according to UNOS. And the new policy would result in only 1% of donated livers being diverted to other recipients than under current regulations, Burdick said.
Currently, fewer than 0.1% of patients waiting for livers suffer from acute organ failure. Unless these patients receive a replacement liver quickly, however, they face almost certain death. In addition, patients who were otherwise healthy before the rapid onset of liver failure have a higher likelihood of successful transplants, Burdick said.
Everyone seems to agree that the best answer for ill patients would be more donated livers.
"We put all our energy into how we divide the pie," said Abraham Shaked, a surgeon who heads the liver transplant program at Hospital of the University of Pennsylvania. Instead, he said, society needs to boost organ donation rates to reduce the importance of allocation. "There are enough organs around; it's a matter of educating potential donors," he said.