Revised U.S. organ transplant policy probed by senators

Two senators formally criticized a major change to the nation's system for selection priority for organ transplants. This is the first sign that Congress may wade into a controversy that pits major medical centers in different states against one another.

Sens. Jerry Moran (R-Kan.) and Roy Blunt (R-Mo.) this week sent a strongly worded letter to HHS Secretary Alex Azar about a Dec. 3 decision by the board of United Network for Organ Sharing, or UNOS, to move away from the long-standing geography-based system for allocating available organs. UNOS is charged with overseeing organ allocation policy on behalf of the Organ Procurement and Transplantation Network, which contracts with HHS.

Moran and Blunt told Azar they found the board's decision, which overruled a recommendation narrowly approved by the UNOS liver committee, "extremely concerning."

The liver committee had been mostly divided between two separate policy proposals its members had developed.

HHS' Organ Procurement and Transplantation Network, or OPTN, "process needs to be open, transparent and one that takes into consideration both the expertise of the Liver and Intestine Committee and the public comments submitted by the current liver distribution regions," the senators wrote.

Moran and Blunt also suggested they expect litigation over the new policy. HHS stepped in over the summer to demand that UNOS move away from its geography-based system after six patients awaiting transplants in California, New York and Massachusetts sued the department.

"The department's decision to intercede due to a lawsuit makes us question whether the department has faith in the outcome of OPTN decisions," they said. "It also makes us expect that the department will weigh in should a lawsuit be filed now that a new OPTN decision was reached."

UNOS' new rules move away from a system that prioritizes a transplant patients' physical proximity to an available organ. Under the new system, the patient with the most urgent need for a transplant will have first claim on any compatible organ within a 150-mile radius, then a 250-mile radius and on up to a 500-mile radius. This process will continue with the priority given to the sickest people.

State interests have long collided over the issue, leading to years of gridlock over a policy overhaul. States in the Midwest and South, colloquially referred to as the "stroke belt," have more organs available for transplant than transplant candidates.

Other states, primarily California and New York, have far fewer organs available relative to the number of people on the waiting list for a transplant.

Dr. Sander Florman of the Recanati/Miller Transplantation Institute in New York's Mount Sinai Health System, responded to the lawmakers' letter in support of the change.

"In a system that is fundamentally handicapped by having too few organs for too many patients that need them, decisions need to be made and should favor saving the most lives and helping the sickest of our patients first," Florman said, adding that this new system model, out of the dozens that have been studied, "balances equitable distribution with logistical considerations."

The UNOS board is made up of transplant surgeons from various states, transplant recipients and donors.

Analysis of the new policy is projected to lower the death rate of transplant candidates and boost the number of pediatric liver transplants, according to UNOS.

UNOS spokesman Joel Newman said the OPTN has aimed since 2012 to "significantly reduce geographic variation in how sick liver candidates must become before they are likely to receive a transplant."

He noted that the liver committee's recommendation, "as with public comment and input from UNOS regions, is advisory" to the board, which approved the new policy this month.