A federal judge in Atlanta on Monday allowed the controversial new national distribution system for livers to take effect today.
But the legal fight will continue. Several health systems that oppose the new policy immediately appealed U.S. District Judge Amy Totenberg's decision not to grant them a preliminary injunction postponing the system.
Even as she allowed implementation to proceed, the judge was clear she had reservations.
"The court remains deeply concerned that the government's decision to proceed at this juncture ... may itself cause disruption in equitable and efficient liver transplant administration and allocation down the line," the judge wrote. "But that is for another day now."
She also noted that she didn't have much time to review a case that poses a tangle of legal and medical questions.
The plaintiff hospitals include Emory University Hospital and Piedmont Hospital in Georgia; the University of Michigan; and the University of Kansas Hospital Authority. Patients who expect to lose their place in the line for a liver transplant were also plaintiffs in the lawsuit.
These hospitals are set to lose a chunk of their lucrative liver transplant business under the revised policy. They sued HHS in late April and asked the court to stop implementation of the new system, due to launch April 30. In light of the litigation, HHS agreed to delay the rollout until May 14 to give the court time to weigh in.
The policy was approved by the United Network for Organ Sharing, or UNOS, is a stakeholder board tasked by HHS' Health Resources and Services Administration to oversee the national organ allocation system. The UNOS liver committee approved the new policy last December.
On Tuesday UNOS applauded the decision as bringing "long-awaited relief to seriously ill patients awaiting a life-saving liver transplant."
"The new liver allocation policy will save lives," UNOS said.
However, the group acknowledged how divisive the politics have become over a policy that has long pitted regions of the country against one another.
"Regardless of the ultimate outcome of the legal proceedings, UNOS will strive to reunite all parties and focus on what at our core unifies us—the vital work of saving lives," the group said. "We will work with the community in a transparent process to evaluate the policy and determine if it is having the intended effect."