University of Iowa Hospitals and Clinics' Organ Transplant Center joins lawsuit against liver allocation process

New federal policy would shift organ donations from Iowa to other states

Alan Reed

University of Iowa Hospitals and Clinics Organ Transplant Center
Alan Reed University of Iowa Hospitals and Clinics Organ Transplant Center

The University of Iowa Hospitals and Clinics has joined 13 other transplant centers across the country to oppose a federal policy that would shift how liver donations are allocated to transplant candidates around the country.

The policy — set to go into effect this coming Tuesday until officials deferred implementation until May 14 — drastically would change the qualifications for how patients in need of a transplant are selected to receive organ donations.

The new policy not only could mean life and death for some patients, but it points to a larger systematic problem within the United States organ donation and transplantation system, said Dr. Alan Reed, director of the UIHC’s Organ Transplant Center.

“To protect the patients in the state of Iowa, we had to join this litigation,” he said.

Earlier with week in an interview with The Gazette, Reed said, “All we’re doing here is rearranging deck chairs on the Titanic. We are not solving the root problem.”

The suit was filed in Atlanta against the U.S. Department of Health and Human Services and the United Network for Organ Sharing, a federal-private partnership that manages the nation’s organ transplant system.

The Health Resources and Services Administration directed the policy not go into effect until May 14 to give the judge time to consider the case. A hearing is scheduled for May 7.


Reed said the lawsuit was filed “by like-minded transplant centers across the country who believe the process by what the way these rules were made are wrong and are unfair, especially to those of low socio-economic means.”

The policy was approved at the end of last year by the United Network for Organ Sharing and the Organ Procurement and Transplantation Network.

Under this new rule, patients with the most urgent need for a transplant can receive a liver from a compatible donor within a 150-mile radius, then a 250-mile radius and finally up to a 500-mile radius.

This replaces the previous distribution system, which was based on a geographic area that gave priority to transplant candidates who lived nearby.

“We believe that we have developed a sound policy that provides a fairer, more equitable system for all liver patients – no matter where they live – as they wait for a lifesaving transplant,” said UNOS Spokeswoman Anne Paschke in an email. “The reality is that, on average, three people die every day in the U.S. while waiting for a liver transplant, and because this new policy will save more lives by reducing the number of patients who die while waiting, we believe it is an improved policy and a step in the right direction.

“This new policy is projected to reduce waitlist mortality by roughly 100 fewer deaths each year, will allow more children to receive life-saving transplants, and will correct an inequity that emerged over time within the old policy that led to unfair advantages and disadvantages based on where liver transplant recipients live.”

According to the lawsuit filed this week, the new policy “will result in at least 20 percent fewer liver transplants being performed in the most socioeconomically disadvantaged regions in the country, which are served in part by transplant center plaintiffs’ liver transplant programs.”

“Based on the government’s own data, transplant center plaintiffs will perform 256 fewer transplants per year — leaving 256 candidates at risk of imminent death absent the transplant they would have otherwise received,” the lawsuit stated.


Experts say this will have the biggest effect on states in the Midwest and the South, which have a higher number of available livers and a relatively short waiting list.

The East and West Coasts, however, have the opposite situation — not enough donors for a long list of waiting recipients.

In some cases, the UIHC’s Reed said that means a patient in areas such as Chicago, Minneapolis, Detroit and St. Louis would have to pass on a liver before it would come back to a patient in Iowa.

The University of Iowa’s Transplant Center is the only one in the state that performs liver transplants.

“We don’t have the same population base as those states, and it’s far more likely will have someone sicker at all times then we will,” Reed said.

However, those in support of the policy say it is a sensible change that helps guarantee better patient outcomes across the country.

Suzanne Conrad is chief executive officer of the Iowa Donor Network, the only Organ Procurement Organization in the state.

She said the network’s boundaries end at the Mississippi River and the Missouri River, so even though a transplant candidate in Omaha, Neb., had a compatible organ in Council Bluffs, that organ would not have been sent to them first.


“In the old system, we would offer it first maybe to Iowa City, rather than across the river,” Conrad said.

More than 13,500 individuals across the country are on the waiting list for a liver, but only roughly 7,000 livers currently are available to candidates, according to federal data.

According to the United Network for Organ Sharing, about 9,500 transplants of all organ types have taken place between January and March of this year.

Somewhere between 6,000 to 8,000 people die while on the waiting list every year, according to a study from the Bridgespan Group.

There are 605 Iowans on the waiting list right now, with 23 individuals waiting for a liver, according to the Iowa Donor Network.

In 2018, 31 individuals in Iowa died while on the waiting list.

Shifting the demand

Greg Segal, co-founder of Organize — a not-for-profit policy organization focused on reform of the organ donation system — said the liver policy is an ineffective fix for a larger, systematic problem with how organs are procured and allocated across the country.

He said the policy is shifting the demand to meet the needs with other areas, but does not address why the need is greater in some parts of the country than others.

“It’s not just shuffling papers around, it’s deciding who’s going to live and who’s going to die,” Segal said.


Segal pointed to a lack of accountability for Organ Procurement Organizations — which self-report and self-review data to federal officials — that allows them to underperform.

There are 58 Organ Procurement Organizations across the country. According to a study conducted by the Bridgespan Group, many of these organizations are “persistent underperformers.”

The Iowa Donor Network, for example — an Organ Procurement Organization — is recovering less than 40 percent of viable organs in the state, the study said.

The Iowa Donor Network’s Conrad pushed back on the criticism, saying there are specific metrics that must be met for an individual to be a viable organ donor.

While there were roughly 2.8 million deaths in 2018 in the United States, about 16,000 actually were eligible to be donors, according to the Association of Organ Procurement Organizations. In the end, fewer than 11,000 individuals received authorization to donate organs.

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