Trans­plant com­mu­nity still split on or­gan do­na­tion and al­lo­ca­tion

Modern Healthcare - - THE WEEK AHEAD - —Sabriya Rice

Ge­o­graphic dis­par­i­ties in ac­cess to or­gans re­main a ma­jor is­sue in the U.S. Some in the trans­plant com­mu­nity say a pro­posal to fix the prob­lem fo­cuses too much on “shuf­fling or­gans” and too lit­tle on boost­ing low donor 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 some at­ten­dees said the pro­posed model wouldn’t solve the prob­lem of low donor rates.

UNOS, the not-for-profit that con­tracts with the fed­eral gov­ern­ment to over­see the or­gan trans­plant sys­tem, will present a re­vised ver­sion of the sys­tem re­design at a liver dis­tri­bu­tion fo­rum on June 22 in Chicago. The group will seek public com­ment. The model 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 con­trib­utes to 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.”

Still, dis­agree­ment per­sists on the idea of shift­ing re­gional pri­or­i­ti­za­tion for pa­tients on the waitlist while only marginally ad­dress­ing vary­ing do­na­tion rates around the coun­try. “I was not in fa­vor of the con­cept last year and I’m still not,” said Dr. David Gold­berg, as­sis­tant pro­fes­sor of gas­troen­terol­ogy at the Univer­sity of Penn­syl­va­nia School of Medicine.

A re­cent study in JAMA In­ter­nal Medicine in­di­cated that poli­cies in many states have failed to in­crease do­na­tion rates. But at least a few states have boosted do­na­tions, Gold­berg said. “Clearly there is po­ten­tial,” he said. “Some­thing they are do­ing must be work­ing.”

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