In Brief

Support Improved Access to Lifesaving Organs: Defend the New Liver Allocation Policy


Geographic Disparities in Liver Allocation Have Cost Thousands of Lives

  • For decades, access to a liver transplant in America has not been equal. Patients who reside in certain disadvantaged localities have to wait much longer and become much sicker before receiving a transplant.

  • This tragic disparity is avoidable. It is the result of an archaic system that downplays patient need and prioritizes arbitrary regions for liver allocation.

Governing Law and Regulations Require Equity in Organ Access

  • The National Organ Transplant Act (NOTA) clearly requires the HRSA to ensure “equitable allocation of donated organs.”

  • In 1994, Congress clarified its intent “to ensure patients that no matter who they were, or where they live, they would have a fair chance of receiving a necessary organ transplant.”

  • In 1998, HRSA released a Final Rule requiring implementation of policies “that provide organs to those with the greatest medical urgency … wherever they live.”

  • The Organ Procurement and Transplantation Network (OPTN) was designated by Congress to develop policies that comply with NOTA and the Final Rule.

Patients Sued HHS to Challenge the Current Inequitable Policy

  • Attorneys representing individuals currently awaiting liver transplants filed a lawsuit against HHS demanding that liver allocation policy be based on medical priority in compliance with underlying law.

  • The suit follows the precedent set by Holman v. HHS, after which HRSA directed OPTN to implement a new lung allocation policy.

  • In response to the suit, on July 31, HRSA sent a letter to OPTN concluding that the previously adopted liver allocation policy violates NOTA and directing the body to establish a new policy by December 2018.

 OPTN Adopted Policies that Substantially Improve Access and Reduce Disparities

  • In December 2018, after several years of public comment and debate, OPTN voted overwhelmingly to adopt a liver allocation policy that eliminates arbitrary geographic boundaries and prioritizes patient need, to be implemented by May 1, 2019.

  • This new system, labeled the “Acuity Model,” substantially reduces the average sickness of patients at the time of transplant nationwide, reduces costs to the transplant system, and will save lives.

  • The Acuity Model permits sharing within radiuses of up to 500 miles and applies only to patients whose acuity of liver failure is above a certain threshold.

The New OPTN Policy Must be Defended so that it is Implemented As Soon As Possible

  • Transplant centers in regions of the country that have historically enjoyed preferred access to liver transplants have vowed to block the OPTN policy.

  • Members of Congress representing those areas have issued statements condemning the expert board’s vote and committing to blocking implementation of reforms.

  • Meanwhile, over 16,000 people are on the waitlist for a life-saving liver.  

  • We ask all who support improved, equitable patient access to liver transplants to stand with us to defend the new OPTN reforms against efforts to undermine them and maintain the status quo, including via authorizing legislation or riders to the appropriations process.