I don’t know how to feel about this blog post to be quite honest. I know that the allocation & final rules vary organ to organ, so I can only speak to lungs, not liver. I wish though, that the Health Affairs Blog would have made that distinction in the title of this post because this clearly only addresses livers. Not other organs in contrast or comparison, so it’s not a wholly balanced discussion.
The analysis in the post is based on this study, which they quote as recent, but was published in 2013.
I don’t deny that disparities in locations & access exist across organ donation as a whole. But to oversimplify the issue can be dangerous as well because then it seems to discourage people from registering to be donors or listing if they need a transplant.
I agree that more policies need to be looked at, reviewed, & possibly changed to alleviate shortages & broaden the pool across the board. That said, I don’t think posts like these do any favors to help the cause.
Yet, I commend the authors for calling attention to the issue, even with a limited discussion. As a whole, the subject is frequently overlooked & under addressed.
Perhaps changes are needed in the allocation of livers.
While the lung allocation scoring system currently being utilized is not perfect (not sure there is a perfect system for it), it allows so many more people (including myself) to get transplants sooner than they might have been able to otherwise before the change was made a few years ago. There are less people are dying on the list, period, as a result of those changes. Sicker people are transplanted now that might have been considered too sick to transplant in the past & turned away, which I also see as a good thing.
Livers obviously are a different animal too because there is the potential to receive either a living donor lobe or a cadaver-based organ which is advantage some organs do not presently have. Or transplant surgeons have tried in the past to expand to using living donation but have almost abandoned the practice since the living donor organ graft failed more often than not & the overall outcomes were poor in comparison to use of cadaver organs). This is not discussed. Furthermore, they point out problems but offer no other alternatives or solutions to balance their argument.
(The main argument appears to be focused on changing locational access, which I see the point of, but there’s no proof to show either way that it will eliminate the current disparity or diminish it. Nor, are there any specific changes put up for a more equitable scoring process than what has been proposed & implemented. I feel that these factors seem to make this post lack balance. They also fail to mention whether they have mentioned these specific gripes to UNOS when UNOS invites the public to participate in policy reviews and potential changes & what if any response they received back from the organization.)
That line between too sick to transplant & not sick enough to list sometimes between various organs is a more thinly veiled line than most people realize.
Also, individual cases & transplant criteria amongst centers also varies widely. Some centers will disqualify certain histories or diagnoses while others take a more aggressive stance & will not disqualify a patient having GERD or a history of a certain illness or treatment procedure that might make the transplant surgery a bit more difficult.
It is therefore, inherently a more complex issue than most people realize or this blog touches on.
Yet, I felt overall, this blog post, & the journal article it references (which is available as a PDF or full text from the site) was worth a read & discussion.
I don’t deny it poses ethical quandaries. It’s a subject of ongoing discussion.