Geographic disparities in access to organs remain a big problem in the U.S., and some members of the transplant community say a pending plan to fix it focuses too much on "shuffling organs" and too little on boosting stagnant donation rates.
During a heated public forum last year the United Network for Organ Sharing suggested a major redesign of the system for allocating livers. But its use of mathematical algorithms and complex statistical tools resulted in harsh words from some attendees, who said the approach would not address the widely varying donation rates that are the root of the problem.
UNOS, the not-for-profit that contracts with the federal government to oversee the nation's organ transplant system, will present a revised version at a liver distribution forum on June 22 in Chicago. The group will seek additional public comment. If well-received, the concept could become policy by mid-2016.
“Whatever we come out with will be a lot better than what we have now,” said Dr. David Mulligan, chair of the group's liver and intestinal organ transplantation committee. The current system, he said, contributes to the widening disparities in liver transplantation rates. The proposed concept “will involve some compromises,” he said. “But this is all about trying to do the right thing for patients.”
However, disagreement persists about the organization's plans to shift regional prioritization for patients on the waitlist while only marginally addressing the variability in donation rates in the country.
“I was not in favor of the concept last year, and I'm still not,” said Dr. David Goldberg, an assistant professor at the University of Pennsylvania medical school. Any model that shifts organs to places with low donation rates should also include major efforts to boost donations in those areas, he said.
Goldberg's recent study in the American Journal of Transplantation challenged the notion that low donor rates in certain geographic areas can be attributed solely to demographic and cultural differences.
A recent study in JAMA Internal Medicine indicated that many state policies have failed to increase donation rates. But at least a few states have successfully boosted donations, Goldberg said.
“Clearly there is potential," he said. "Something they are doing must be working."