It's estimated that of the 17,000 Americans currently waiting for new livers, 6,000 will receive a transplant and 1,500 will die waiting. However, in 2014, 10 percent of donated livers went unused, according to a new article in The Atlantic.
A recent study published in the Journal of Hepatology examined the relationship between decisions to reject organs and the number of patients dying on the waitlist. Here are eight things to know about wasted organs.
1. The U.S. is split into 11 Organ Procurement and Transplantation Network regions with varying disparity in organ availability and waitlist times. The preservation and transportation of organs is a knotty business. Researchers have been trying to reduce these discrepancies for years.
2. The study conducted by a team of researchers from the University Of Pennsylvania School of Medicine in Philadelphia examined data on 23,000 liver offers across all 11 OPTN regions. Only 37 percent of the 23,000 were accepted for the first (the most sick) person on the transplant list.
3. The study found considerable differences in the rates of accepted livers between institutions. These disparities remained even after researchers took organ quality and facility size into account. Some accepted up to 58 percent of liver offers, others just 16 percent. These discrepancies even applied to centers located in the same OPTN region.
4. While there are many visible reasons physicians could reject a liver, researchers believe that there is another less-obvious motivating factor behind organ rejection. The Scientific Registry of Transplant Recipients releases assessments of transplant centers every six months. One-year post-transplant survival rates are a crucial metric. A poor assessment results in the institution being flagged, which can lead to Medicare and Medicaid refusing to pay for patients' transplantation at these centers and can cost institutions millions.
5. In 2014, three transplant centers were flagged. In 2015, all three of those transplant centers performed about 30 percent fewer transplants. "You're only accountable for the patients that you transplant," Kevin Cmunt, CEO of the organ-procurement organization Gift of Life, is quoted in The Atlantic. "So if you don't transplant somebody, you can't get in trouble."
6. John Roberts, MD, the chief of transplant surgery at the University of California, San Francisco, is quoted in The Atlantic as saying that the current system "puts pressure on people to try and make sure that they're using the best organs that they can...not listing patients who may otherwise benefit from transplants because they're too old or sick...It's a problem that no one has a great solution to."
7. The United Network for Organ Sharing is working on a pilot program to determine alternative measures for transplant center assessment. It hopes to begin testing these measures in 2017.
8. "Patients, providers and insurers really don't know anything about this stuff," David S. Goldberg, MD, assistant professor of medicine at the University of Pennsylvania and one of the study's authors, is so quoted in The Atlantic. Dr. Goldberg believes organ acceptance rates should publicly available, believing transparency a step towards solution.
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