Federal Action Could Stop Unneeded Surgeries, Experts Say

Article excerpt

TORONTO -- Federal rules need to change to protect patients from receiving unnecessary liver transplants, leading surgeons said at the American Transplant Congress here.

"We are concerned," said Dr. Elizabeth A. Pomfret, chairman of the liver and intestinal organ transplantation committee of the United Network for Organ Sharing, the federally funded agency that manages the nation's transplant system. "The new challenge is, can we improve upon the current allocation system? I think it's very possible that we could."

The Tribune-Review in March reported hundreds of patients each year undergo liver transplants when they have better odds of living at least a year by waiting. Often, these people near the bottom of the waiting list receive organs that were rejected for thousands of sicker patients.

Crediting the Trib with highlighting the problem, UNOS officials are reviewing the practice and are expected to address the issue at the liver committee meeting next month.

At last week's transplant congress, a gathering of about 4,500 surgeons, scientists and other medical professionals discussed the problem and proposed changes.

Too often, centers perform transplants for the wrong reasons, said Dr. Richard Rohrer, chief of transplant surgery at Tufts-New England Medical Center.

"There is a huge amount of self-interest," Rohrer said. "There are marketplace incentives to do these transplants. It's not about the science anymore."

They discussed changes focused on systems for ranking patients and giving out organs.

Rankings are based on a score called MELD, for Model End-stage Liver Disease, that predicts whether patients on the waiting list will die within three months but says little about their life expectancies after surgery.

The system could be changed to favor recipients who have more years to gain from an organ, said Pomfret, a transplant surgeon at the Lahey Clinic Medical Center in Burlington, Mass.

The so-called net benefit of a transplant -- the number of years a transplant recipient could expect to gain from surgery -- could be determined in part by looking at objective, measurable medical criteria such as the recipient's disease and age, Pomfret said.

Columbia University researchers have studied a change that would include the odds of dying within three months after transplant as well as waiting list mortality. …