Rep. Yoder Spearheads Letter Opposing Proposed Changes to Rules for Liver Transplants

For Immediate Release

September 15, 2014

Contact: Laken Avonne Rapier

Phone: (202) 225-2865

Overland Park, KS – Congressman Kevin Yoder (R-KS), along with more than 50 of his colleagues, has written to Administrator Mary Wakefield, at the Health Resources and Services Administration, to express concerns regarding a concept paper released by the United Network for Organ Sharing (UNOS) Liver and Intestine Committee. The proposed concept paper would change the rules governing the allocation of livers for transplant. Under these proposed changes from UNOS, the geographic boundaries for sharing of donor livers would be significantly broadened, with the goal of reducing the disparities in liver allocation across the country. Wider geographic organ sharing will increase access for larger, urban transplant centers on the east and west coasts while limiting organ availability for patients in the rest of the country, such as regions in the midwest and south. The UNOS Liver and Intestine Committee is expected to meet in Chicago on September 16 to discuss this proposal.

“There is a critical shortage of donor livers in the United States and a large geographic disparity in the rates of organ donation,” said Congressman Yoder. “Kansans, and the Midwest as a whole, are historically generous organ donors and UNOS should not adopt proposals that punish successful programs and decrease access to organs where donation rates are highest. We must implement programs that raise the organ donor consent rate in the areas of the country where disparities in wait times are the greatest.”

Currently, there are over 12,000 patients listed for liver transplant and typically 6000 liver transplants performed annually. In addition to this letter, more than 40 transplant professionals from across the country have also expressed significant concerns regarding the scientific and economic rationales of the UNOS proposal.

The full text of the letter is reproduced below.

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Mary K. Wakefield, PhD, RN

Administrator

Health Resources and Services Administration

5600 Fishers Lane Rockville, MD 20857

Dear Administrator Wakefield:

We are writing to express our concern regarding a concept paper released by the United Network for Organ Sharing (UNOS) Liver and Intestine Committee in July 2014 that would change the rules governing the allocation of livers for transplant. As you know, UNOS operates under the oversight of the Health Resources and Services Administration (HRSA), and we request that you take steps to ensure this concept paper is evaluated in a fair and open manner with equal time given to views in opposition to and in favor of the proposal.

If implemented, the proposal would result in dramatic adverse impacts for individuals with liver disease throughout the United States. More organs for transplant would travel significantly longer distances, areas with high organ donation rates would be disproportionately affected, organs would experience longer cold ischemic times, and the proposal may not have the desired effect of lowering overall wait list mortality. In addition, the administrative burdens and costs imposed on the organ procurement infrastructure would be unprecedented and could inadvertently reduce the number of livers available for transplant nationally

Our immediate concern is a Liver and Intestine Committee forum scheduled for September 16 in Chicago to address the UNOS concept paper. More than 40 transplant professionals from across the country recently wrote to you expressing significant concerns regarding the scientific and economic rationales as well as the fairness of this UNOS proposal.

A review of the agenda for the upcoming meeting indicates there will not be adequate time available for discussion of alternative approaches or viewpoints. We urge you to let UNOS know you expect equal time be allotted to viewpoints that differ from the concept paper. Moreover, the concept paper should not have progressed to this point without more robust scientific evidence from prior policy changes for the allocation of livers (Share 35) that UNOS implemented only one year ago. Before proceeding with any additional changes in allocation policy, the scientific community should gather and evaluate at least three years of outcomes and quality data on Share 35.  In the interim, we urge the transplant community to focus on alleviating geographic disparities by improving community education and donation rates throughout the country.

We also remain concerned that the concept paper is moving forward without full adherence to the plain meaning and intent of the language on liver allocation policy that Congress included in Conference Report 111-366 accompanying the 2010 Appropriation Act for the Departments of Transportation and Housing and Urban Development.  We appreciate your attention to this important matter.

CC: Dr. Carl Berg MD, President OPTN/UNOS Board of Directors

CC: Dr. David Mulligan MD, FACS, Chair Liver & Intestinal Organ Transplantation Committee