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Transplant centers, patients unite to stop new organ sharing policy that threatens longer waits for a liver

Apr. 23, 2019, 1:46 PM


Vanderbilt University Medical Center and 13 other highly regarded liver transplant centers have filed a lawsuit aimed at stopping federal policy changes that are slated to take effect Tuesday, April 30, that will affect thousands of patients across the Southeast and Midwest waiting for donor livers.

The new policy, known as the “Acuity Circles Policy,” was adopted by the United Network for Organ Sharing (UNOS) in its capacity as the nation’s Organ Procurement Transplantation Network (OPTN). The policy will result in a dramatic shift from sharing donor livers based on patients’ medical needs within their region of the country to sending donor organs up to 500 nautical miles away from each donor hospital.

The new policy means that residents of Tennessee and other affected states will face longer wait times for a life-saving donor liver, creating greater risk for their survival.

The “Acuity Circles Policy” is the result of lobbying efforts by large hospitals in the Northeast and on the West Coast, where organ donation rates are among the lowest in the nation, so they can gain greater access to donor livers.

“The current liver allocation policy prioritizes patients based on their acuity and geographic proximity to available donor organs. If adopted, the Acuity Circles Policy is predicted to increase deaths in rural areas, decrease the number of overall transplants throughout the country, needlessly increase the risk of teams traveling to procure organs and increase costs,” said Seth Karp, MD, professor and chair of the Section of Surgical Sciences at Vanderbilt University Medical Center and director of the Vanderbilt Transplant Center.

“The Acuity Circles Policy dramatically reduces the accountability that local areas have for increasing donation rates and in many cases rewards places with poor donation,” Karp added. “The real solution to the shortage of livers is to increase donation, not simply move organs around.”

The lawsuit, filed on April 22 in federal court in the Northern District of Georgia, is on behalf of the named patient plaintiffs and the transplant centers, acting on their own behalf as well as the interests of all their end-stage liver disease patients who face a significantly increased risk of death if the policy is implemented.

According to the lawsuit, the Acuity Circles Policy was adopted in obvious and unwarranted haste based on demonstrably false assumptions and was the product of an opaque, reckless process that has life and death consequences.

The centers filing the injunction to stop Acuity Circles are Vanderbilt University Medical Center (TN), University of Kansas Health System (KS), Saint Luke’s Hospital of Kansas City (MO), Washington University in St. Louis/Barnes-Jewish Transplant Center (MO), Emory University (GA), Henry Ford Health System (MI), Indiana University Health (IN), Michigan Medicine (MI), Oregon Health & Science University (OR), Piedmont Healthcare (GA), University of Iowa (IA), University of Kentucky (KY), and University of Virginia Health System (VA) and VCU Health System (VA).

These centers care for 11% of the 13,100 people currently waiting for a liver transplant. The medical experts at these centers agree that in addition to increasing organ donation, UNOS/OPTN must balance the distribution of donor organs without doing harm to people who live in socioeconomically depressed areas with less access to health care and greater risk of dying on the waitlist while waiting for a transplant.

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