Tom Wilemon

twilemon@tennessean.com

Discussions next week in Chicago about geographic disparities in liver transplants could mean the difference between life and death for people like Brian Wyatt.

He has liver disease and is lucky enough to live in a region of the United States with a high organ donation rate, so his odds of getting a transplant at Vanderbilt University Medical Center are much higher than if he were on the West Coast or the East Coast. The United Network for Organ Sharing is considering a proposal to even out those odds.

UNOS may redraw liver-sharing regions. The new map would result in more donations from Tennessee being shipped to states beyond its existing district, which also includes Kentucky, North Carolina, South Carolina and Virginia.

Vanderbilt’s liver transplant center is one of 60 across the nation that have gone on record against the redistricting proposal. Directors of those centers have signed a letter saying the proposal represents “the most drastic change in liver allocation ever and would significantly disadvantage many areas of the country currently able to serve their patient populations.”

Although he is not on a transplant list, Wyatt is keeping a close watch on the proposal because his doctor has told him he may someday need a new liver. He compares it to political gerrymandering and says areas of the country with low donation rates simply need to get more people to sign up as organ donors.

“What they are wanting to do is take the areas of high donation rates, like the South, and turn them into an organ farm to send them from areas of high donation rates to areas of low donation,” Wyatt said. “That is their proposal in a nutshell.”

Wide disparities

Jill Grandas, executive director of Tennessee Donor Services, a Nashville-based nonprofit that promotes organ donations and works to make them happen, said her organization is in a “making-an-assessment mode.” She will be at the meeting in Chicago on Tuesday to hear the discussion. She just worries about confusion and controversy causing fewer people to sign up as organ donors.

“We work very closely with Vanderbilt,” Grandas said. “We want to make sure we are doing our very best to serve the needs of the patients of Tennessee. When Tennesseans can’t benefit from the organs that are recovered here, we want to make sure that we are able to maximize the donations of folks.”

The disparities for getting a liver are wide, according to an article published last year in the American Journal of Transplantation that proposed new regional maps. The 90-day probability of a wait-list death for a liver transplant varies from 14 percent to 82 percent among donation service areas, the article noted.

Dr. Seth Karp, director of the Vanderbilt Transplant Center, said reconfiguring liver allocation regions is a more complicated solution than others that should be considered. In Tennessee, around 80 percent of individuals and families say yes when approached about organ donation, he said, which is significantly higher than in California, New York or New England.

“There have been a lot of people who are calling for an investigation as to why that is and for best practices to be put in place to try to get those numbers higher in places that don’t have such high numbers,” Karp said.

The letter that he and the other transplant center directors sent to Mary Wakefield, head of the U.S. Health Resources and Services Administration, which has oversight of UNOS, spells out several concerns. Those include a lack of analysis about how effective expanded regional districts would be, the shifting of transplant resources from rural areas to urban ones, the lack of a plan to solve the shortage in liver donations and the increased costs of air flights as well as the additional risks to medical professionals.

“Unless you get more livers, it is hard to imagine how you can save more lives,” Karp said. “In some ways, what this represents is a way to reallocate the organs but not necessarily to save any more lives. I think that’s what we need to start talking about. How are we going to save more lives?”

Reach Tom Wilemon at 615-726-5961 and on Twitter @TomWilemon.

Liver donations

While liver donations have increased in Tennessee since 2006, the opposite has occurred in New York and California, which have much bigger populations.

Tennessee New York California 2013 287 313 716 2012 265 334 696 2011 246 360 723 2010 239 357 663 2009 296 392 648 2008 223 353 687 2007 223 435 712 2006 236 455 783

Source: Organ Procurement and Transplantation Network

How to help

Sign up to be an organ donor when renewing your driver’s license. Make sure there’s a red heart near the photo. Drivers must sign up every time they renew. Visit www.donatelifetn.org or call 877-552-5050.

Died while waiting

Percentage of people needing livers who died on the waiting list without a transplant from July 2011 to June 2012.

Wait time Vanderbilt United States 6 months 3.6 percent 5.7 percent 12 months 3.6 percent 7.6 percent 18 months 5 percent 8.7 percent

Source: Scientific Registry of Transplant Recipients