CALL TO ACTION: UNOS Liver and Intestinal Organ Transplantation Committee addresses challenges in fair access to liver transplants posed by geographic disparity.
Public forum addresses equity in liver distribution
UNOS Liver and Intestinal Organ Transplantation Committee addresses challenges in fair access to liver transplants posed by geographic disparity but efforts are again on hold for now as per UNOS.
The survey results are here.
UNOS Update-Rosemont, Ill. – Approximately 400 people attended a public forum held on Sept. 16 to discuss various concepts to reduce geographic variation in access to liver transplantation.
The opinions and recommendations expressed will help theOPTN/UNOS Liver and Intestinal Organ Transplantation Committeeas it continues to assess potential improvements to liver transplant policy.
“At this point, no specific policy recommendation has been determined,” said Carl Berg, M.D., OPTN/UNOS President. “But this ongoing discussion has identified a number of areas of focus, as well as key questions and concerns that need to be answered in developing any future proposal.”
The forum addressed concepts distributed for public input in June 2014. Results of a questionnaire that accompanied the document were also shared and further discussed at the forum.
The OPTN/UNOS Liver and Intestinal Organ Transplant Committee is discussing feedback from the questionnaire and the forum at its regularly scheduled meeting today.
Here is the original post and please note the call to action is still in effect. UNOS would like to hear your opinion.
Please also reference this blog post for more information and statistics offered by both sides.
CALL TO ACTION” The OPTN/UNOS Liver and Intestinal Organ Transplantation Committee continues to seek public input on a concept document addressing issues in liver distribution. The concept document includes a link to a questionnaire, where any individual or institution can comment. Responses to the questionnaire will be accepted through Friday, July 11.
Additional details regarding the forum agenda and registration will be provided in mid-July.
The idea is to read the paper and learn as much as possible so an opinion can be formed at some point. Remember, your opinion counts just as much as anyone else’s opinion.
A concept paper was published by UNOS on behalf of The UNOS Liver and Intestinal Organ Transplantation Committee.
The concept paper summarizes challenges in fair access to liver transplants posed by geographic disparity, concepts under current consideration, and alternative approaches investigated.
There are currently 11 regions.
UNOS Liver Committee estimates that changing the number of regions to four would lead to a reduction of 581 deaths of people on a liver transplant waiting list.
Having eight regions, another possibility, would cause a reduction of 342 deaths.
The UNOS Liver and Intestinal Organ Transplantation Committee’s paper states that under the current system, “candidates in some parts of the country must wait until they are very sick before they receive a liver transplant, while those in other parts of the country may receive transplants when they are much less ill.”
Dr. David C. Mulligan, chairman of the UNOS Liver and Intestinal Organ Transplantation Committee, stated that an important goal is to reduce deaths of people on a transplant waiting list.
More people are dying on wait lists than ever before, Mulligan said. The geographic disparity in allocations of organs for transplants, he said, “is unacceptably high.”
Mulligan said some people now getting transplants could safely have waited longer. “We want to be fair,’’ he said. “Hundreds of lives are at stake.”
Livers generally are allocated to patients within a local service area, followed by the transplant region. The 11 regions that now exist have wide variations in patients and available organs.
The purpose of remapping would be to equalize the MELD scores, a measure of severity of liver disease. That system is a numerical scale used for adult liver transplant candidates. The organs generally go to the sickest patients (by MELD score) within a region.
There are many areas of the country that object to the proposed changes. Georgia is one example and this article will help put their issue in perspective.
Read the article here.
The idea of such a change has already been drawing fire in Georgia. Transplant surgeons here contend that redrawing the districts would hurt the state. Right now, the region that includes Georgia works efficiently in terms of organ donations and distribution, Emory and Piedmont transplant chiefs point out.
The median MELD score in Georgia for liver transplants in 2011 was 25 to 28, while in California and a large section of the Northeast, it was 29 or more, the UNOS paper said. Under the current set-up, the wait time in Georgia for a liver transplant is less than six months, Piedmont’s Johnson said. And he added that Georgia is now a net exporter of livers, sending 10 to 12 to other states each year.
The OPTN/UNOS Liver and Intestinal Organ Transplantation Committee stated Monday that reducing the nation’s number of transplant regions — from the current 11 to four — could save hundreds of lives.
The United Network for Organ Sharing panel said its aim in the initiative is to reduce the current geographic variation in patient access to liver transplants.
The OPTN/UNOS Liver and Intestinal Organ Transplantation Committee requests feedback from the transplant community, other stakeholders and the public regarding next steps to consider as it seeks to increase equity in access to liver transplantation.
• The OPTN system is divided into 11 geographic regions. The regional boundaries were based upon historic organ sharing relationships. While the regional structure was developed originally to facilitate organ allocation and to provide individuals with the opportunity to discuss issues regarding organ procurement, allocation and transplantation that are unique to their particular geographic area, the regions were not designed for optimal organ distribution. -UNOS Liver Committee
The liver committee also decided that distribution should not begin at the local level but should, instead, begin at least at the broader regional level.
The Liver Committee agreed upon the following parameters for these optimized maps:
• The number of districts should be at least 4 and no more than 8;
• The minimum number of transplant centers per district is 6;
• The maximum median travel time between DSAs placed in the same district is 3 hours;
• The number of waitlist deaths under redistricting must not be statistically significantly
higher than in the current system;
• The districts should be contiguous.
Any interested person or organization was encouraged to read the concept document and respond to the questionnaire by July 11, 2014.
The committee also hosted a public forum regarding liver distribution on Tuesday, September 16, 2014, at the Hilton Rosemont Hotel. The hotel is located approximately two miles from Chicago-O’Hare International Airport, with shuttle service available from the airport. Responses to the concept document questionnaire will be used to develop discussion topics for the forum.
Note: Original Liver Concept Questionnaire Deadline was July 11; Public forum was scheduled for September 16 at the Hilton Rosemont Hotel in Chicago.
Source: northwestgeorgianews.com, Dr. David C. Mulligan, UNOS Liver and Intestinal Organ Transplantation Committee, UNOS.org Concept Document with an eye toward producing proposals for next spring.