Blue America to Start Farming Livers in Red America

Liver transplant distribution changed after years of debate

After years of debate, the organization that oversees the allocation of livers for transplant took steps Monday to address a long-standing geographic disparity in supply of the scarce organs.

The policy approved by the Organ Procurement and Transplantation Network will make more livers available in some places — including cities such as New York and Chicago — where the shortage is more severe than it is in regions such as the southeastern United States.

“The essential thing to stress about this proposal is that it does move things in the direction we want to go, across the country,” said Julie Heimbach, chairwoman of the committee that developed the proposal after considering 63 alternatives over more than five years of often-heated debate.

Many speakers Monday described the approach as a compromise that most could adopt but that completely pleased few.

David S. Goldberg, a hepatologist at the University of Pennsylvania’s Perelman School of Medicine who has studied the liver disparity, said in an email that he has concerns about the policy because it does not consider liver donation rates, which vary sharply across the country.

The United Network for Organ Sharing (UNOS)

 regional map showing how the country is 

currently divided into regions for liver

 distribution. (United Network for Organ Sharing)

But, Goldberg said, “in the spirit of compromise and maintaining the value of democratic debate and discussion within our transplant community and the broader public, I can support this proposal.”

The geographic disparity in available livers has plagued transplant patients for decades. The United Network for Organ Sharing, the nonprofit organization that coordinates organ transplantation, divides the country into 11 regions for the purposes of liver distribution.

In Region 9, for example, which includes New York, just 327 livers were donated in 2016, continuing a pattern of meager procurement that goes back ­decades. In Region 3, which includes the Deep South and Puerto Rico, 1,336 livers were obtained from deceased donors.

That is partly because the Deep South is the center of the nation’s “stroke belt,” where higher rates of obesity, high blood pressure and diabetes lead to fatal strokes, leaving more donors with intact livers. Many Southern states also have above-average death rates from traffic accidents.

So rural America has more livers available because of strokes and car accidents and a more charitable disposition, and urban America has excess need for livers due to Hep C and other diseases, and urban America thinks it's owed them livers.