Myths About Organ Distribution Reform

This month’s theme is focused on debunking some of the most common #TransplantMyths found in the organ distribution reform discussion today. While the merits of distribution reform have been well documented, the debate is often saturated with misleading information. It’s important to have a constructive, fact-based dialogue when discussing the need for liver distribution reform.

Here are four of the most common myths about organ distribution reform:

Myth # 1: Distribution reform often does not consider addressing the need to increase the number of donors, as well as the performance of organ procurement organizations in underperforming regions.

Throughout the debate, the importance of a parallel aim to increase the number of organs donated has been well-emphasized. The notion that organ distribution reform fails to address the necessity to increase organ donation is simply untrue. Past proposals have sought to make sure people everywhere throughout the U.S. can have a similar chance of receiving an organ based on need, rather than their place of residence.

CODE strongly supports efforts to increase the total number of transplants. Rather than rewarding one specific area at the expense of another, we believe policies should sought that makes sure patients nationwide who are most in need will have a better chance of accessing organs for transplant no matter where they live.

Myth # 2: UNOS proposals will increase cost and reduce the number of transplants being performed, causing some transplant centers to close.
 
While any policy that redistributes organs over a broader area can reasonably be anticipated to raise transport time, distance, and the amount of organs flown, CODE has supported policies that minimizes each of these metrics compared to any other potential option. A hypothetical (and modest) reduction in overall transplants modeled under past proposals should not prevent adoption of a policy that would reduce significant disparity inherent in our current system and save lives overall.
 
Myth #3: Any projected decline in the number of liver transplants significantly outweighs geographic disparity.
 
While past models have shown reductions in the number of transplants available, the projected losses are diminutive. A small-scale drop in overall transplants does not equate to the hundreds of lives that would be saved under the policy or the rampant current geographic inequity. CODE strongly believes that this reduction will be offset by behavioral changes and logistical improvements.
 
Myth #4: Congress created the OPTN to support reasoned, expert-based and consensus driven decisions in organ allocation policy.  UNOS proposals have been contradictory to that expectation as evidenced by their unpopularity among members of the transplant community and the general public.
 
Although critics have decried the UNOS process for procedural shortcomings, there is limited evidence to defend these claims – including those alleging conflicts of interest in the policymaking process. For example, NIH awarded a challenge grant in 2009 to reduce geographic disparities in transplant access to a multi-disciplinary and multi-institutional team led by Krista Lentine (nephrologist, Saint Louis University) that included Sommer Gentry (mathematician, U.S. Naval Academy), Dorry Segev(transplant surgeon, Johns Hopkins), David Axelrod (transplant surgeon, Dartmouth), and Mark Schnitzler (health policy researcher, SLU). This grant funded Gentry’s initial work on redistricting U.S. liver allocation, which eventually resulted in development of the redistricting concept.

Billy Wynne