Dr. Adel Bozorgzadeh chief of the Division of Organ Transplantation at UMass Memorial Medical Center - University Campus in Worcester, discusses what changes in organ transplant rules will mean for patients locally. [T&G Staff/Steve Lanava]
By Susan Spencer
Telegram & Gazette Staff
Posted Jan 31, 2019 at 6:00 PMUpdated Jan 31, 2019 at 6:00 PM
WORCESTER - For 30 years, the chance that someone who needed a liver transplant would actually get an appropriate liver in time depended at least as much on geography as on how sick the patient was.
But under a policy change approved in December by the board of directors of the Organ Procurement and Transplantation Network/United Network for Organ Sharing, patient severity of illness will weigh more heavily in allocating available organs to waiting patients.
As a result, after the policy change goes into effect April 30, patients with end-stage liver disease in places such as New England and New York, which have a lower supply of available organs relative to the need, will fare better than under the current rules.
“This really has been a long overdue change,” said Dr. Adel Bozorgzadeh, chief of the division of organ transplantation at UMass Memorial Medical Center.
UMass Memorial has been a center for liver transplants since the 1990s. In 2018, 66 liver transplants were performed there, according to U.S. Health and Human Services data.
There were 274 liver transplants in Massachusetts last year, out of 8,250 performed nationwide.
Dr. Bozorgzadeh said, “These new rules are going to level the playing field. Hopefully it’s going to decrease the risk of waitlist mortality, so that really is different.”
The current long-standing distribution policy grew out of enactment of the National Organ Transplant Act in 1984, which was passed to address the nation’s critical organ donation shortage and improve the organ matching and placement process.
The law established the Organ Procurement and Transplantation Network, which maintains a national registry for organ matching. OPTN contracts with the nonprofit United Network for Organ Sharing, or UNOS, to operate the matching network.
The policy was based on 11 geographic regions set up across the country. Because organs from deceased donors can only be kept alive and usable for a few hours - it’s about 10 hours for livers - the idea was to place available organs with the closest patients in need.
The expectation was that the incidence of disease and availability of organs would match, Dr. Bozorgzadeh said. “In reality, over the next three decades we would see nothing farther from the truth.”
He said patients would be gravely ill in intensive care units at UMass Memorial or other transplant centers in the region, but no liver would be available. At the same time, someone in Pittsburgh or Indiana, for example, who was only half as sick, would get a liver.
“There’s a significant strain on our population,” Dr. Bozorgzadeh said.
The reasons for the mismatch reflect geographic differences in population age and causes of death, according to Dr. Bozorgzadeh.
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