The new rules for liver transplantation begin in the battle for fairness

WASHINGTON (AP) – Wilnelia Cruz-Ulloa spent the last months of his life in a hospital in New York City, waiting for a liver donation that would never have come. The doctors had urged the 38-year-old to move to another state with more organs. But she could not afford it.

Your place of residence affects your state of health in order to obtain a transplant or the fact that you are dying in waiting. Now, the country's transplant system aims to make the liver wait, and possibly all organs, less dependent on your postal code. New rules requiring a wider sharing of liver donations came into effect on Tuesday despite the fierce and ongoing war in the hospital world before a federal court.

"The sickest should have the greatest opportunity" for an organ, said Dr. Sander Florman, transplant surgeon at Mount Sinai Medical Center in New York, who helped take care of Cruz-Ulloa and pushed for change . "This woman would be alive if the new rules were in place or if she had lived elsewhere."

But more than a dozen Midwestern and Southern hospitals have sued to block the change, arguing that it would put their patients at risk, especially in rural areas, if the livers were to be transported more. far away in areas where donations were lower. Late Monday, an Atlanta judge denied their request to put the rules on hold until the court challenge was decided. The next day, these hospitals appealed, always seeking to end the rules after they came into effect.

At a hearing last week, US District Judge Amy Totenberg made it clear that the debate weighed heavily: "Transplant issues have this vital and emotional dimension, which affects everyone involved."

More than 13,000 people are waiting for a new liver, according to the United Network for Organ Sharing, which manages the country's transplant system. Last year, barely 8,250 people had a transplant, the vast majority of which came from deceased donors. On average, three people die each day while waiting.

It's just livers. Overall, the UNOS registry indicates that around 114,000 people are waiting for an organ transplant.

WHY IS GEOGRAPHY IMPORTANT?

Some parts of the country, especially the Midwest, have given more organs than others, such as New York and California, where the shortage of organs is the most serious.

And for decades, the transplant policy has been "local first" – meaning that organs are usually first offered to the sickest patients in the same area as the donation, even if a sick person outside the local border is fine. The country's 11 transplantation regions are subdivided into local areas with individual waiting lists, with wide variations in the availability of organs within and between regions.

Some patients are looking for shorter waiting lists away from home, like Apple's late CEO, Steve Jobs, who was living in California but received a liver transplant in 2009 in Tennessee, which was at the time one of the shortest expectations.

For Cruz-Ulloa, a dental assistant at Medicaid in New York, it was not a choice. After waiting several years, she died in October.

"They told us," In Florida, you could have the liver faster, "Wendy Gomez, Cruz-Ulloa's wife, recalls. "I say to myself" But how are we going to settle in Florida and leave everything behind? "

CHANGE

Cruz-Ulloa was part of a lawsuit filed last summer that liver distribution cards violated federal law. For example, a liver could be shipped to Pittsburgh nearly 400 km from Englewood (New Jersey) before being offered to the nearby city of New York. The government asked UNOS to find a solution.

The new policy: Near-death patients within 500 nautical miles (575 miles) of a donor hospital will be offered a liver. If there is no taker, it will be offered to progressively less sick patients, at different distances in this circle. As is the case today, physicians will use a medical test score that predicts patients' risk of death over the next few months to classify patients on hold.

The UNOS predicts that a wider liver sharing will save more than 100 lives each year, as the worst scores get a transplant before those whose scores suggest that they can wait a little longer.

A similar sharing of lung transplants began last year; changes for other bodies are underway.

SOME HOSPITALS REALLY STRUGGLE

Hospitals that have been cross-referenced believe that the new policy is also unfair. They report that people in more rural areas are already facing inequities, such as reduced access to health care, which puts them at greater risk of dying from various diseases.

If all organ banks recruited as many donors as the Midwest, there would be 1,000 more liver transplants a year, said Dr. Sean Kumer of one of the hospital's plaintiffs from Kansas. "We managed to do that, and now people come to our area of ​​the country to harvest organs."

Costs will increase as transplant teams go further to procure organs, added a recent report from the Washington University of St. Louis that examined the early months of a larger lung distribution. Specialists once mentioned where a team from St. Louis and another from Chicago were flying over to each other at about the same time to recover lungs from such sick recipients.

The UNO pledged Tuesday to assess whether the new rules on the liver have the desired effect, recognizing that "the period has been difficult" with regard to conflicts between transplant centers.

The biggest problem: "I do not think we can solve the problem of equity as long as the number of available organs will not be greater than the demand," warned Kevin O. Connor, President of LifeCenter Northwest, an organ procurement organization, who also heads a UNOS Geography Committee. before the last court fight.

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AP reporter Jeff Martin in Atlanta contributed to this report.