January 10, 1997

Transplant questions draw VUMC surgeon to national hearings

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Dr. C. Wright Pinson (center), director of the Vanderbilt Transplant Center, examines patient Robin Ritter along with Dr. Ken Richards. Pinson recently testified at a national hearing examining liver transplant allocation policie

Transplant questions draw VUMC surgeon to national hearings

One of the goals of the Vanderbilt Transplant Center is to be involved in formulating public policy about the issue.

Dr. C. Wright Pinson, professor and vice-chairman of the Department of Surgery and Surgical Director of the Vanderbilt Transplant Center, helped meet that goal recently when he and Vanderbilt's first liver transplant patient traveled to Bethesda, Md. to testify about the nation's current liver allocation policy.

Pinson and Julie Damon of Brentwood, who received the first liver transplant at Vanderbilt VUMC in 1991, both testified at the public hearings on Dec. 10, 11 and 12. The hearings were sponsored by the U.S. Department of Health and Human Services.

The purpose of the hearings was to help the department assess the issues associated with the allocation of human livers for transplant, to review the Organ Procurement and Transplantation Network (OPTN) policy and possible alternatives, and to seek ideas on how to increase organ donation. The OPTN policy was recently revised to redefine Status One patients, those in the most critical need of a liver.

"We went to testify because it's important that they hear what the view is from the majority of liver transplant programs," Pinson said. "We represented the Tennessee Transplant Society and our center at Vanderbilt."

Based on the testimony from the hearings, Donna Shalala, the Secretary of Health and Human Services, will determine in the next three months which of the liver allocation policies she believes promises the best results for patients awaiting livers in the United States.

In a September letter co-signed by the directors of 70 other transplant centers, Pinson urged the department to maintain the current allocation and distribution system for livers. The policy is based on an underlying philosophy of local primacy.

"We strongly discourage a move away from the current system," the letter read.

At the December hearings, Pinson restated this opinion. He publicly addressed the importance of the United Network for Organ Sharing (UNOS), a contractor to the DHHS that manages organ procurement for transplantation programs across the country.

"The UNOS process has worked for over a decade, not because it is perfect, but because it is as fair and balanced as possible in dealing with these difficult issues. UNOS has done a credible job of managing the OPTN and represents the fairest and most comprehensive means of achieving a reasonable allocation system that currently is possible," Pinson testified.

Pinson said local primacy is important because it provides better quality organs and increased utilization for available organs; it encourages community participation; it provides shorter preservation times; and it minimizes the expense associated with the transportation of organs.

He also told the group that the best care for the transplant patient can be provided in close geographic proximity because the patients require intensive continuing care.

"It would be difficult for any party to argue that it would be less expensive to provide care far from home, especially for the uninsured and those with low income, all other things being equal," Pinson said in his testimony.

Transplant patient Julie Damon told the group she believes she is better off today because she was able to receive her new liver close to home. Because the transplant was performed less than 30 minutes from her home, she was able to benefit from family support.

"It is not merely that having the transplant regionally was convenient. I don't believe I would have lived without the emotional support of my family," she said in her testimony.

"Life is beautiful for me. Every day I remain thankful that a liver became available for me. I am thankful that I was able to go to a top-rate hospital so close to my home to have my transplant. I am a true believer that a doctor-patient-hospital-community relationship is extremely important for all involved."

In his testimony Pinson offered the following recommendations to the Department:

€ Currently, the best policy for liver allocation is the one delivered by the UNOS board in November. This covers the questions about criteria for entering patients, definition of status, and provides regional boards to ensure compliance. It will be modified appropriately over time by the UNOS process.

€ Current center waiting times, along with patient survival rates, should be published so they can be easily obtained by patients on the waiting list. This provides information directly to patients and allows them to make decisions about various factors. Within a short period of time, this will do more for equalizing access than any change in UNOS or government policy.

Pinson closed with a plea for more donors.

"At best, only four out of 10 potential donors become actual donors. As a result, eight to nine people per day die waiting for a transplant and the national waiting list is at 50,000," he said.

"Education about donation and belief in fair and unbiased donor and transplant systems are the cornerstones to improve the desperate plight of those in need of a transplant," Pinson said. "The fairness issue is an important factor in people making a decision to donate their organs. The public's continuing willingness to donate organs depends heavily on the perception of this system as unburdened by issues of political, racial or economic bias."