Let Livers Go Where They're Needed

Toddler Emma Lowney waited nine months for a new liver.

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 with a simple adjustment in the way the 6,000 or so livers from deceased donors are allocated -- to see that the organs more often go to the Americans who need them most.

Under the existing system, managed by the United Network for Organ Sharing, donated livers are prioritized for use in the geographic regions from which they come. In regions where the organs are relatively plentiful -- in 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 map of liver-donation regions to create just four large ones in place of the 11 smaller ones that exist today. Mathematical models suggest that sharing livers within these broader zones would save 554 over five years.

Granted, the share of livers that would need to be transported by air would rise to about three in four -- from less than one in two under the present system, because a liver must be transplanted within 18 hours of removal from a blood supply. That means recovery teams would also have to travel farther. But 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 a donated organ fear they would lose out. And it's true that some would have to wait longer for a transplant. 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. Yet research contradicts this notion: 82 percent of respondents to a 2013 survey 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 life-saving organs shouldn't depend on where they live.

Corrects number of lives saved in first and third paragraph.

--Editors: Lisa Beyer, Mary Duenwald.

To contact the editor on this story:
David Shipley at davidshipley@bloomberg.net