Let Liver Transplants Go Where They're Needed

Access to lifesaving transplants shouldn't depend on where you live
Photograph by Bernard Weil/Corbis

About 3,000 people die in the U.S. each year for lack of a liver for transplantation. More than 100 of those lives could be saved by ensuring that more of the 6,000 or so livers donated annually in the U.S. go to those who need them most.

Under the existing system, managed by the United Network for Organ Sharing, donated livers are prioritized for use in the regions from which they come. In places where the organs are relatively plentiful—the South, for instance, where death rates are higher—they sometimes go to people who could easily wait longer for a transplant, rather than to sicker patients who may die without them. As a result, the death rate for patients on a liver wait list can vary by a factor of 10 from one part of the U.S. to another.

A new system, put forward by a UNOS committee, would redraw the liver-donation map to create four regions in place of the 11 that exist today. Mathematical models suggest that sharing livers within these zones would save 554 lives over five years.

Granted, recovery teams would have to travel farther. The share of livers that would need to be transported by air would rise to about 3 in 4—from less than 1 in 2—because a liver must be transplanted within 18 hours of removal from a blood supply. Even so, total costs would decline by 4.3 percent, or about $246 million, thanks to savings on expensive care for people with end-stage liver disease.

So what’s not to like about the change? Liver patients and their advocates in areas where it’s now relatively easy to receive an organ fear they would lose out. It’s true some would have to wait longer. But their more robust health would enable them to do so.

Another objection sometimes raised is that expanding the zones would reduce donations, because people would no longer know that individuals in their own communities would receive their donations. Research contradicts this notion: in a 2013 survey, 82 percent of respondents said they would prefer their organ go to the person in greatest medical need, regardless of location.

It’s that concept that should guide the distribution of donated livers nationally. In the age of overnight delivery service, Americans’ access to lifesaving organs shouldn’t depend on where they live.


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