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Back To Vidyya Most Urgent Liver Patients Receive Higher Proportion of Transplants

Transplants Go To Those Patients Who Need Them The Most

A United Network for Organ Sharing (UNOS) analysis of recent changes to U.S. liver transplant policy indicates that urgent patients receive a large and increasing proportion of donated livers.

Patients who risk imminent death within days without a transplant (UNOS Status 1 and 2A patients), as a group, received 34 percent of liver transplants between August 1, 1999, and May 31, 2000. This represents roughly a 50 percent increase over patients similarly classified (then UNOS Status 1) in 1997. It occurred despite the fact that current Status 1 and 2A patients, combined, comprise only one-half of one percent of the national waiting list for liver transplants.

"This shows that UNOS policy recognizes and strives to meet the needs of the sickest patients," said UNOS President Patricia Adams, M.D. "However, we must carefully balance medical need with the obligation to make the best use of donated organs."

UNOS has instituted several significant revisions to liver allocation policy since 1998. Perhaps the single most influential action, adopted in 1999, mandated that livers be offered to any eligible Status 1 patient throughout the UNOS region where they are donated before they can be considered for any less urgent patients at a local level. UNOS has 11 regions, serving total populations ranging from 12.3 million to 42.8 million.

"One consequence of the policy changes," noted Dr. Adams, "is that fewer patients are being transplanted earlier in their disease process." The proportion of UNOS Status 3 (least urgent) patients receiving liver transplants has declined roughly 500 percent since 1997, to nine percent currently. "These patients, as a group, tend to have less complications than those who are transplanted at a critical stage. Ideally, were more organs available, we could better meet the needs of both groups." UNOS is currently evaluating new policy proposals with two interdependent goals: to better define patients' medical urgency and to consider optimal areas for initial allocation of livers. The UNOS Board of Directors will consider policy recommendations in November. UNOS will then forward final recommendations to the U.S. Department of Health and Human Services (HHS). Under federal regulation implemented in March, HHS will have final approval of national allocation policy.

UNOS maintains the U.S. organ transplant waiting list and brings together medical professionals, transplant recipients and donor families to develop organ allocation policy under contracts with the Health Resources and Services Administration of the U.S. Department of Health and Human Services. UNOS also collects, analyzes and publishes more data on a single field of medicine than any other U.S. organization.


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Editor: Susan K. Boyer, RN
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