House ‘Dear Colleague’ Opposing New Liver Allocation Policy Includes Numerous Inaccuracies
The current policy has been recognized by all constituents as illegal and inconsistent with NOTA. Advocates of halting the implementation of the new policy are really asking for the current, illegal policy to remain in place. There is no legal or medical basis for doing so and will simply result in courts deciding what should be a question for the transplant community.
The new liver allocation policy was supported and approved by a supermajority of the OPTN Board of Directors, which consists of representatives of all stakeholders in the transplant community. For years the proponents of this letter have advocated for deferring to the transplant professionals at the OPTN. Now they reverse course and seek to halt a policy passed by those same transplant professionals.
The new liver policy will save lives. It is estimated to result in an eight percent reduction in waitlist mortality.
The sickest patients everywhere will benefit from increased access to livers for transplant under the new system, regardless of where they live. Under the current, illegal formula, arbitrary geographic boundaries (known as Donor Service Areas and Regions) everywhere (including in the South and Midwest), often deny the most needy patients access to organs that were relatively close by.
There is no connection between organ procurement and allocation. Some of the highest performing procurement programs have the longest liver waitlist times. For example, California has some of the best performing programs and the longest liver waitlist.
There is no evidence supporting the assertion that organ donation will be higher if they are kept locally for transplant. In fact, in a 2012 survey conducted by the U.S. Department of Health and Human Services, 82 percent of respondents said they prefer their donated organs go to the most medically needy patients, regardless of where they live.
The assertion that the total number of transplants will go down assumes no change in the ways hospitals accept or decline livers after the new system is put in place, which is just a limitation of the simulation model and very likely to be inaccurate.
The same argument was made when Share 35 went into effect and the number of transplants actually increased. Surgeon and transplant center behavior and acceptance patterns will change with the new system. No one really believes there will be any decrease in the number of transplants.