Where you live drives wait for liver transplants

[Guest guest]

> Where you live drives wait for liver transplants

>

> [AP]

>

> By LAURAN NEERGAARD, AP Medical Writer n Neergaard, Ap Medical

> Writer – Mon Feb 14, 4:51 pm ET

>

> WASHINGTON – Doctors dropped another bomb soon after telling

> Rosiello it was time for a liver > transplant:

> The 21-year-old isn't likely to get one any time soon in his home state

> of New York. Consider traveling to Ohio, they advised, where the wait's

> a lot shorter.

>

> Where you live plays a big role in how sick you are, and how long you

> wait, before getting a scarce liver transplant — if you survive long

> enough. Now the network that runs the U.S. organ transplant system is

> exploring steps to ease some of the disparities. Critics who want more

> nationwide sharing of donated livers fear any changes won't help

> enough.

>

> " I'll go anywhere for my son. This is his life, " says 's mother,

> Randy Rosiello of New York City, who has begun researching waiting

> lists from Ohio to North Carolina as the family debates its next step.

>

> But she doesn't think her son should have to leave his doctors at New

> York's Mount

> Sinai

> Medical Center, or undergo the stress of travel. Plus, she worries, " if

> I have to go, I'm putting my family into financial ruin. "

>

> The nation has a severe shortage of donated livers. More than 16,000

> people are awaiting a liver transplant, and just 6,300 a year get one.

> More than 1,400 others die waiting each year.

>

> Since 2002, the sickest patients have been ranked atop waiting lists to

> receive a liver from a deceased donor. They're given a so-called MELD

> score, based on laboratory

> tests,

> that predicts their risk of death. Rising scores move them up on the

> waiting list. The change by all accounts has greatly improved the

> system, which once was based instead on time spent waiting.

>

> Here's the lingering trouble: Patients with liver

> failure

> and would-be donors are not distributed evenly around the country. And

> the nation is divided into 11 transplant regions that have wide

> variations in patients and available organs, between regions and within

> them.

>

> A donated liver is offered first to the sickest patients in the local

> transplant center, and if there's no good match, then to the sickest

> patients throughout that transplant region. If there's still no good

> match, the liver can go to someone who's not as sick — rather than to

> someone sicker in the next transplant region.

>

> Patients can shop around for shorter lines, even get on more than one

> list, if they have the means to get to a far-away hospital within hours

> of a liver becoming available. For instance, Apple CEO Steve Jobs' 2009

> liver transplant was in Tennessee, where the wait was much shorter than

> back home in California.

>

> But Mount Sinai liver transplant chief Dr. Sander Florman says that

> system isn't fair to those who can't afford to maximize their chances.

>

> " If a patient can get on an airplane and go to Florida, why can't the

> liver get on an airplane and come to New York? " he asks.

>

> For patients like Rosiello, the news that New Yorkers wait

> longer for a liver complicates already agonizing treatment choices.

>

> When he was a baby, Rosiello had complex liver surgery for a rare birth

> defect, biliary atresia, and more surgery a few years ago that

> postponed a transplant. But now repeated liver infections and other

> complications have put him in the hospital three times in about a

> month, require IV care and forced him to quit college. Still, his MELD

> score is low, something doctors warn could change rapidly — but that

> also means he should consider a place with a shorter wait.

>

> " He's frightened to death, " says Randy Rosiello as the family peruses

> an Internet database — the Scientific Registry of Transplant Recipients

> — that compares wait times and success rates.

>

> How big are the differences? The United Network for Organ

> Sharing

> says that in three regions stretching from Ohio down through Tennessee

> and on to Florida, adults receiving new livers in the past year had

> median MELD scores of 23 to 24. But in the New York and western Vermont

> region, liver recipients were far sicker, with a median score of 32.

> Only the region that includes California fared worse, with 37.

>

> Within regions, rates of people who die on the waiting list or become

> too sick to transplant range from fewer than 10 percent to more than 25

> percent each year.

>

> So UNOS' liver committee is seeking feedback from transplant

> centers

> about options to improve, in hopes of proposing changes later this

> year.

>

> Topping the list: If a liver isn't a good match to the sickest patients

> within one region — as measured by a MELD of 15 or more — offer it

> nationwide before giving it to a less sick local patient.

>

> But small steps won't help the toughest regions, contends Mount Sinai's

> Florman.

>

> New York transplant centers suggest splitting the country into four or

> five " super regions " where the sickest patients in the entire zone

> would get first dibs. No, livers don't last outside the body as long as

> kidneys that often are shipped long distances. But Florman says his

> hospital successfully flies in livers from Florida that hospitals there

> turn down as less-than-optimal — because, say, the donor was elderly —

> meaning better organs should have no problem.

>

> And often less-than-optimal organs go to waste, because of restrictions

> on when hospitals can take a chance with them, adds Dr. Fishbein

> of town University Hospital in Washington, D.C., another hard-hit

> area.

>

> Bigger moves would encounter more resistance, cautions Dr.

> Washburn of the University of Texas Health Science Center, who chairs

> UNOS' liver committee and views modest change as an important first

> step. A proposal for regional sharing that skipped the local transplant

> center prompted " a lightning rod " of objections from hospitals that

> stood to lose organs, he says.

>

> Indeed, centers with shorter waits say they do a good job of

> encouraging organ donations and other regions should try to improve.

>

> " If you equate it to hunger, people try to figure out how to come up

> with more food, not which kid gets the sandwich, " says Dr. ph

> Tector, transplant chief at Indiana University Health.

>

> While short-term relief is needed, more organ donation is the long-term

> answer, agrees town's Fishbein: " It's only because we're so short

> of livers that we fight over the livers that are there. "

>

> ___

>

> EDITOR'S NOTE — n Neergaard covers health and medical issues for

> The Associated Press in Washington.

>

> Online:

>

> Transplant center data:

> http://www.srtr.org

>

> United Network for Organ Sharing:

> http://www.unos.org

>

> ___

>

> Online:

>

> http://www.srtr.org

>

> http://www.unos.org

>

>

[Guest guest]

> Where you live drives wait for liver transplants

>

> [AP]

>

> By LAURAN NEERGAARD, AP Medical Writer n Neergaard, Ap Medical

> Writer – Mon Feb 14, 4:51 pm ET

>

> WASHINGTON – Doctors dropped another bomb soon after telling

> Rosiello it was time for a liver > transplant:

> The 21-year-old isn't likely to get one any time soon in his home state

> of New York. Consider traveling to Ohio, they advised, where the wait's

> a lot shorter.

>

> Where you live plays a big role in how sick you are, and how long you

> wait, before getting a scarce liver transplant — if you survive long

> enough. Now the network that runs the U.S. organ transplant system is

> exploring steps to ease some of the disparities. Critics who want more

> nationwide sharing of donated livers fear any changes won't help

> enough.

>

> " I'll go anywhere for my son. This is his life, " says 's mother,

> Randy Rosiello of New York City, who has begun researching waiting

> lists from Ohio to North Carolina as the family debates its next step.

>

> But she doesn't think her son should have to leave his doctors at New

> York's Mount

> Sinai

> Medical Center, or undergo the stress of travel. Plus, she worries, " if

> I have to go, I'm putting my family into financial ruin. "

>

> The nation has a severe shortage of donated livers. More than 16,000

> people are awaiting a liver transplant, and just 6,300 a year get one.

> More than 1,400 others die waiting each year.

>

> Since 2002, the sickest patients have been ranked atop waiting lists to

> receive a liver from a deceased donor. They're given a so-called MELD

> score, based on laboratory

> tests,

> that predicts their risk of death. Rising scores move them up on the

> waiting list. The change by all accounts has greatly improved the

> system, which once was based instead on time spent waiting.

>

> Here's the lingering trouble: Patients with liver

> failure

> and would-be donors are not distributed evenly around the country. And

> the nation is divided into 11 transplant regions that have wide

> variations in patients and available organs, between regions and within

> them.

>

> A donated liver is offered first to the sickest patients in the local

> transplant center, and if there's no good match, then to the sickest

> patients throughout that transplant region. If there's still no good

> match, the liver can go to someone who's not as sick — rather than to

> someone sicker in the next transplant region.

>

> Patients can shop around for shorter lines, even get on more than one

> list, if they have the means to get to a far-away hospital within hours

> of a liver becoming available. For instance, Apple CEO Steve Jobs' 2009

> liver transplant was in Tennessee, where the wait was much shorter than

> back home in California.

>

> But Mount Sinai liver transplant chief Dr. Sander Florman says that

> system isn't fair to those who can't afford to maximize their chances.

>

> " If a patient can get on an airplane and go to Florida, why can't the

> liver get on an airplane and come to New York? " he asks.

>

> For patients like Rosiello, the news that New Yorkers wait

> longer for a liver complicates already agonizing treatment choices.

>

> When he was a baby, Rosiello had complex liver surgery for a rare birth

> defect, biliary atresia, and more surgery a few years ago that

> postponed a transplant. But now repeated liver infections and other

> complications have put him in the hospital three times in about a

> month, require IV care and forced him to quit college. Still, his MELD

> score is low, something doctors warn could change rapidly — but that

> also means he should consider a place with a shorter wait.

>

> " He's frightened to death, " says Randy Rosiello as the family peruses

> an Internet database — the Scientific Registry of Transplant Recipients

> — that compares wait times and success rates.

>

> How big are the differences? The United Network for Organ

> Sharing

> says that in three regions stretching from Ohio down through Tennessee

> and on to Florida, adults receiving new livers in the past year had

> median MELD scores of 23 to 24. But in the New York and western Vermont

> region, liver recipients were far sicker, with a median score of 32.

> Only the region that includes California fared worse, with 37.

>

> Within regions, rates of people who die on the waiting list or become

> too sick to transplant range from fewer than 10 percent to more than 25

> percent each year.

>

> So UNOS' liver committee is seeking feedback from transplant

> centers

> about options to improve, in hopes of proposing changes later this

> year.

>

> Topping the list: If a liver isn't a good match to the sickest patients

> within one region — as measured by a MELD of 15 or more — offer it

> nationwide before giving it to a less sick local patient.

>

> But small steps won't help the toughest regions, contends Mount Sinai's

> Florman.

>

> New York transplant centers suggest splitting the country into four or

> five " super regions " where the sickest patients in the entire zone

> would get first dibs. No, livers don't last outside the body as long as

> kidneys that often are shipped long distances. But Florman says his

> hospital successfully flies in livers from Florida that hospitals there

> turn down as less-than-optimal — because, say, the donor was elderly —

> meaning better organs should have no problem.

>

> And often less-than-optimal organs go to waste, because of restrictions

> on when hospitals can take a chance with them, adds Dr. Fishbein

> of town University Hospital in Washington, D.C., another hard-hit

> area.

>

> Bigger moves would encounter more resistance, cautions Dr.

> Washburn of the University of Texas Health Science Center, who chairs

> UNOS' liver committee and views modest change as an important first

> step. A proposal for regional sharing that skipped the local transplant

> center prompted " a lightning rod " of objections from hospitals that

> stood to lose organs, he says.

>

> Indeed, centers with shorter waits say they do a good job of

> encouraging organ donations and other regions should try to improve.

>

> " If you equate it to hunger, people try to figure out how to come up

> with more food, not which kid gets the sandwich, " says Dr. ph

> Tector, transplant chief at Indiana University Health.

>

> While short-term relief is needed, more organ donation is the long-term

> answer, agrees town's Fishbein: " It's only because we're so short

> of livers that we fight over the livers that are there. "

>

> ___

>

> EDITOR'S NOTE — n Neergaard covers health and medical issues for

> The Associated Press in Washington.

>

> Online:

>

> Transplant center data:

> http://www.srtr.org

>

> United Network for Organ Sharing:

> http://www.unos.org

>

> ___

>

> Online:

>

> http://www.srtr.org

>

> http://www.unos.org

>

>