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
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.