The federal judge tasked with the immediate fate of the nation's new liver-matching system warned she might hold the government in contempt if it doesn't immediately halt implementation of the revised policy.
U.S. District Judge Amy Totenberg threatened the federal government with sanctions if it moves forward with matching livers to transplant candidates in order to prioritize the sickest transplant candidates.
Totenberg scheduled another hearing of the case for May 21, as the bitter legal battle escalates.
United Network for Organ Sharing, or UNOS — the group that oversees organ distribution in the U.S. on behalf of HHS — said in a statement Friday afternoon that the group is "in the process of reverting back" to the geography-based system.
"Reprogramming this complex and important system is not a simple process and will take time to execute," UNOS said. "However, it is underway now and UNOS will have a greater sense of when the work will be completed next week.
The group also alerted transplant candidates that donated livers will continue to get matched to people on the waiting list. The computer program is currently following the new policy that rolled out on Tuesday.
Judge Totenberg issued her latest order shortly after UNOS said it would continue matching livers to transplant candidates according to the new policy.
UNOS had doubled down on its position Thursday after Judge Totenberg declined to elaborate further on a Wednesday order, where she told the government to pause implementation of the revised policy.
The case has been getting more and more complicated this week. When the judge ordered the delay on Wednesday, she shifted from a position she had held just two days earlier when she told the government and plaintiffs that the policy could move forward as planned while the case moved through the appeals process. In light of her initial decision, UNOS rolled out its new matching system on Tuesday.
But when the plaintiff health systems promptly objected and asked for a delay while an appellate court sorted out the legal complaint, Judge Totenberg agreed implementation should be put on hold. She told UNOS to hit the pause button.
UNOS asked her to elaborate on that decision, and she declined. So UNOS said they would keep matching transplant candidates to livers according to the new rule.
"If ultimately a court directs UNOS to revert back to the prior liver policy, we will do so, but such a process is not immediate and could take weeks," UNOS said late Thursday. "The system is very complex, took six months to develop and implement; therefore it is not simple to transition from one system to another."
The plaintiffs immediately cried foul. They urged UNOS to cease the new policy by May 20. The hospital coalition that is fighting the change includes 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 have also joined the lawsuit.
The new policy was approved last December by UNOS at the urging of the top official of the Health Resources and Services Administration (HRSA). Hospitals with transplant centers are set to lose a chunk of lucrative business under the revision, and remain bitterly opposed to the change — as are transplant candidates who fear they will lose their place in the queue for a liver.
UNOS in its statement noted that last year 1,155 people died awaiting a liver transplant.
"UNOS and its expansive network of experts and professionals remain committed to successful organ transplantation and seeking ways to reduce the number of patients who die each year while waiting," the group said Friday.