Searching For A Fairer Way To Distribute Donor Livers | KUOW News and Information

Searching For A Fairer Way To Distribute Donor Livers

Sep 26, 2017
Originally published on September 27, 2017 7:20 am

Himanshu Patel ran a convenience store in Georgia until about a year ago, when his liver failure got so bad he had to quit.

"I just couldn't stand up on my feet at all," says Patel, 39, of Waycross, Ga. "I just had to stop working."

Now, he's waiting anxiously to learn if his doctors have found a liver for him so he can undergo a transplant.

"They told me, 'You will need a liver transplant — without a liver transplant you might not survive,' " Patel says.

Piper Su is waiting, too. She's also 39 but lives about 700 miles north in Alexandria, Va. She's still working as a lawyer, but says it's getting harder and harder.

"I tend to get very tired," Su says. "Often times, I'll have sharp pains in my abdomen from my liver voicing its displeasure. And then I've developed a condition in my legs, which can be very painful."

Patel and Su are among more than 16,000 Americans waiting for a liver transplant because of conditions such as hepatitis, cancer or cirrhosis. But only about 7,000 livers are donated each year. So they know their odds aren't great.

And their chances also vary based on where they live.

"In some areas of the country, patients have to wait a lot longer than in other areas," says Julie Heimbach, a transplant surgeon at the Mayo Clinic. "They have to get much sicker before they can access a liver transplant, depending on where they live."

Heimbach chairs a committee for the United Network for Organ Sharing, the nation's organ transplant network, which has proposed a new system for distributing livers.

"We're just trying to make it just a little bit more equal so that there's not such a disparity depending on where you live," Heimbach says.

Under the current system, the nation is divided into 11 regions, and the sickest patient on the waiting list in each region gets the next compatible liver that becomes available in that region.

In some regions, patients have to wait until they're facing a 93 percent risk of dying within the next three months. In other regions, patients get transplants when their risk is only 13 percent, according to UNOS.

One big reason for that is that more organs become available in some places than others. And that's partly because of the way people die — there are more deaths in ways that leave the victims eligible to be organ donors, such as car accidents and strokes.

"The heroin epidemic has actually led to a lot of organ donors because when people become overdosed they stop breathing and they become brain dead," Heimbach says. "And certain areas of the country have more or less of that particular problem."

Generally, more livers tend to become available in rural places than in more urban places, such as California, New York City and the Washington, D.C., area.

To try to alleviate the geographic disparities, the new system would expand access to livers to patients listed at a transplant center within a 150 nautical-mile radius of the hospital where the liver is donated, even if it's in a different region.

"Whether they're in or out of the region, as long as they're in that 150-mile circle they would be able to access that donor," Heimbach says. "So it basically kind of expands the regions."

The new plan is the latest attempt by UNOS to address inequities in allocation. It was developed after concerns arose over a previous proposal. But the new plan is still stirring concerns.

"This is life and death stuff for real people," says Raymond Lynch, a transplant surgeon at Emory University in Atlanta.

"When you export a liver, you import a death," Lynch says. "So if you move an organ from one place to another, you've left a hole in that original place and that hole is going to turn into a death because now somebody in that original place doesn't have an organ transplant."

Lynch and others argue that under the new plan, livers would tend to get shifted from less affluent, rural areas to more affluent, urban places.

"We would be hurting those people who are most vulnerable in the U.S. — minorities, people with reduced income, people with reduced access to primary care physicians, people who live in rural locations," Lynch says. "All those people already do worse."

Critics argue that more should be done to increase donations in areas where patients have to wait longer.

"We know that organ donation rates vary greatly across the country," says David Goldberg, an assistant professor of medicine and epidemiology at the University of Pennsylvania who studies access to organ donation.

"New York, which is 90 miles from where I live in Philadelphia, has donation rates that are half of that in Philadelphia and Pennsylvania," Goldberg says. "So if the donation rates in New York were the same as in Philadelphia, it would be a nonissue."

Heimbach agrees that more should be done to increase organ donation rates around the country. But she disputes the argument that the new system would cost lives or make the process less fair.

"It would not be less fair — it would be more fair," Heimbach says. "It's not one-way sharing — where the lives are being taken from one particular part of the country. It's a broader sharing so that the sickest patient, no matter where they are, would access the livers."

Su hopes the new plan will help save her life. Because livers are so scarce where she lives, Su has been traveling to other parts of the country to try to get on waiting lists in as many places as she can.

"It's been a bit of an odyssey," Su says. "I think the best move for everyone involved is to try to move toward, you know, the most fair system possible that gets organs to those who need them most quickly."

But Patel, who lives in a place where more livers are available, worries the change would mean he would have to wait longer for his transplant.

"If I go tomorrow and they tell me I have to wait another six months or something like that, that might put me in a worry," he says. "I don't know if I'm going not make it for six months."

The public has until Oct. 2 to comment on the proposal.

Copyright 2017 NPR. To see more, visit http://www.npr.org/.

DAVID GREENE, HOST:

The nation's organ transplant network is proposing a change in how livers are made available. The idea is to make the system more equitable, but some are worried that this change would make things less fair for some people, and we have more now from NPR health correspondent Rob Stein.

ROB STEIN, BYLINE: Himanshu Patel is 39 and lives in Waycross, Ga. He ran a convenience store until his liver started failing.

HIMANSHU PATEL: And when I went in the hospital, they told me that you will need a liver transplant. Without the liver transplant, you might not survive.

STEIN: So Patel is anxiously waiting for a phone call to find out if his doctors found a liver for him. So is Piper Su. She's also 39 but lives about 700 miles north, in Alexandria, Va. She's still working as a lawyer, but it's getting harder.

PIPER SU: I tend to get very tired. Oftentimes, I'll have sharp pains in my abdomen from, you know, sort of my - my liver voicing its displeasure. And then, you know, I've developed a condition in my legs, which sometimes they retain fluid, which can be very painful.

STEIN: Patel and Su are among more than 16,000 Americans waiting for a liver transplant, but only about 7,000 livers are donated each year. So their odds aren't great. And Julie Heimbach of the Mayo Clinic says their chances depend a lot on where they live.

JULIE HEIMBACH: Some areas of the country, patients have to wait a lot longer than in other areas. They have to get much sicker before they can access liver transplant, depending on where they live.

STEIN: The reason is complicated. Part of it is that more organs become available for transplants in some places than others for lots of reasons. There are more car accidents, more deaths from strokes.

HEIMBACH: The heroin epidemic has actually led to a lot of organ donors because people become - you know, overdose. They stop breathing. They become brain-dead. And certain areas of the country have more or less of that particular problem.

STEIN: So Heimbach helped come up with a new way to distribute livers. Right now the sickest patient on the waiting list in each of 11 regions gets the next liver that becomes available in that region. The new system would basically expand access to livers to patients within 150 nautical miles from wherever the liver is donated.

HEIMBACH: And whether they're in or out of the region, as long as they're in that 150-mile circle they would be able to access that donor.

STEIN: But the plan is raising a lot of concerns.

RAYMOND LYNCH: This is life-and-death stuff for real people.

STEIN: Raymond Lynch is a transplant surgeon at Emory University in Atlanta.

LYNCH: It's important to know that when you export a liver, you import a death. So if you move an organ from one place to another, you've left a hole in that original place, and that hole is going to turn into a death because now somebody in that original place doesn't have an organ transplant.

STEIN: And Lynch argues that the new plan would tend to shift too many livers from less affluent, rural areas to richer, urban areas.

LYNCH: We would be hurting those people who are most vulnerable in the U.S. - minorities, people with reduced income, people with reduced access to primary care physicians, people who live in rural locations. All those people already do worse.

STEIN: Julie Heimbach, who came up with the new system, disputes the argument that it would cost lives and take organs away from people who need them most.

HEIMBACH: It would not be less fair. It would be more fair. It's not one-way sharing where the livers are being taken to one particular part of the country. It's a broader sharing.

STEIN: When you ask the patients what they think about all this, predictably, their perspective depends on where they live. Piper Su, who lives in Alexandria, Va., where livers are scarce, has been traveling around the country to get listed in as many places as she can.

SU: It's been a bit of an odyssey, and I think the best move for everyone involved is to try to move towards, you know, the most fair system possible that gets organs to the people who need them the most quickly.

STEIN: But Himanshu Patel, who lives in Waycross, Ga., where livers are more available, is worried about having to wait longer.

PATEL: They tell me that I have to wait another six months or something like that then that might put me in the worries that, like, I don't know if I'm going to make it for six months or not.

STEIN: The public has until October 2nd to tell the United Network for Organ Sharing what it thinks about this proposal. Rob Stein, NPR News. Transcript provided by NPR, Copyright NPR.