Agency to Study Needless Liver Transplants
Andrew Conte; Luis Fabregas, Tribune-Review/Pittsburgh Tribune-Review
The nation's leading transplant agency has begun to review why some patients undergo liver transplants when they don't need them, top officials said last week.
The United Network of Organ Sharing was prompted to take a closer look at liver transplants by a four-month Tribune-Review investigation that showed how some patients die after transplants when they could have lived longer by waiting, said Dr. Timothy Pruett, UNOS president and director of transplantation at University of Virginia Health System in Charlottesville.
"They should have a longer survival without a transplant than with one, in terms, at least, of early survival," Pruett said. "The part of me that is the doctor part says that you've got to talk to people about this and to let them know that's what their risks are."
As part of its review, the UNOS Liver & Intestinal Organ Committee is looking at cases in which patients who are not critically ill undergo transplant surgery. The committee will determine whether rule changes are needed and report back to the main board, composed of surgeons, administrators and public representatives.
Patients are ranked by a numeric score known as MELD, for Model End-Stage Liver Disease, based on three blood tests and ranging from 6 to 40. Patients with cancer or severe quality-of-life symptoms can apply to a regional review board for additional points.
Those with scores of 14 or lower have higher odds of surviving at least a year if they do not have the transplant, according to research published by the Scientific Registry of Transplant Recipients.
A 2005 UNOS rule was designed to curb such transplants, but some medical centers continue to do them. Four of the nation's 127 liver transplant programs -- including the University of Pittsburgh Medical Center -- performed half of the surgeries on those low- score patients since the 2005 rule took effect.
The UNOS Liver & Intestinal Organ Transplantation Committee reached similar findings after conducting its own analysis, said Dr. John Lake, a committee member and director of liver transplants at the University of Minnesota Medical Center.
"Most of us were surprised there were as many being done as there were," Lake said. …