Judge Overrules Cities Trying to Farm Rural Livers

Also WaPoo (30 day passcode), Federal judge blocks new U.S. policy for distributing livers for transplant

A federal judge temporarily blocked a new policy for distributing scarce livers for transplant Wednesday, deciding that patients and hospitals in less-populated areas will suffer if the new rules remain in effect.

The decision by U.S. District Judge Amy Totenberg in Atlanta came just a day after the policy was implemented. On Monday, she had declined to intervene but had asked the government to voluntarily delay it until the Supreme Court decided a case on relevant issues in coming weeks.

When the Department of Health and Human Services moved forward Tuesday, Totenberg apparently decided to step in. She said patients on the liver transplant list and a group of hospitals, which together filed the lawsuit, would be harmed if the new rules were used.

“Given the gravity of the medical issues and risk of disruption in the transplant system and the concrete likelihood of harm to the plaintiffs and the public at large if the status quo is not maintained, the Court finds that the public interest is best served” by keeping the old policy in place, Totenberg wrote.

The transplant system has struggled for decades to find a fair way to distribute livers, kidney, hearts and other organs in the United States, where a severe donor shortage has created a waiting list of about 114,000.

About 13,500 people are on the list for livers; in 2018, 8,250 of the organs were transplanted, according to the United Network for Organ Sharing (UNOS), a nonprofit organization that runs the transplant system. At least three people die each day while waiting for livers.

For years, transplant hospitals generally had first claim to organs donated in their areas. The new policy offers livers to the sickest patients as far as 500 nautical miles from the donor. It was approved after a lawsuit was filed in New York by patients who said they were waiting longer for livers than less-ill people in other parts of the country. The government, concerned that the policy in place was illegal, ordered transplant authorities to consider another approach.

New York has lots of people; why can't they grow their own damn livers!

The plaintiffs — which include transplant centers in Georgia, Michigan, Kansas and Missouri, as well as people on the waiting list for livers — say the rules will leave patients in those places with about 20 percent fewer organs than the current policy, resulting in an increase in waiting-list deaths.

The plaintiffs contend the new policy will allow big-city transplant centers, where demand is greater, to reach far into areas where the shortage is less severe and take livers that otherwise would go to patients in those regions.

Supporters of the new policy maintain, however, that regional disparities have become too great. For example, they have said, a moderately ill patient in Kansas has a 60 percent chance of receiving a liver within 30 days, while a similar patient in California has just a 1 percent chance.

Living in Kansas has other drawbacks though, I'm sure.

I do wonder about the origin of the disparities. Why do the more rural areas of the country have a relative excess of people dying with healthy livers, and the cities have a deficit. Drugs, HIV and Hep C? A physically more dangerous lifestyle in rural America, more accidents?

Anyhoo, before the feds codify a plan to shift livers from the countryside to the cities, they need to find a way to reward the countryside for producing them, and indemnifying the cities. Maybe a liver transfer tax!

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.