(Courtesy photo.)

Liver transplant policy to be reinstated; feds apologize for mixup

A controversial change in the distribution of donated livers among patients in the U.S. for transplants will be undone this week, officials for the U.S. Department of Health and Human Services and its nonprofit contractor said Monday — much sooner than the four weeks they initially said such action would take.

That means that livers that may have been diverted away from patients in Georgia to patients in other states will once again be allocated closer to home, for the time being. The policy has prompted a legal challenge, and any changes are subject to court orders demanding the government hold off or allowing it set the policy in motion.

Hospitals and transplant patients in Georgia and the Midwest have sued over the reallocation policy, saying the government rushed it through the legal consideration process and that it is also flawed.

The stated idea behind the new policy is to get the few livers available for transplant to the sickest patients, regardless of state boundaries.

The hospitals that are suing say that’s not what’s going to happen because the data the government used is flawed. Instead, they say, a scoring system used to determine the health of candidates for transplants will err in making patients in other states, such as New York, appear to be sicker than similar patients in Georgia. The plaintiffs say patients in rural Georgia who have worse medical support will die on the waiting list. Livers will then be sucked out of other states such as Georgia, they say, and directed toward those patients mistakenly identified as sicker.

It’s impossible to know the specific impact to individual patients over the past week, but one Piedmont Hospital patient who was waiting for a liver spent a week on full life support without receiving one during the brief changeover to the new policy. Sunday night, he died.

The government is implementing a national scoring system that is meant to smooth out scores across the states. That change will continue, the officials said at the hearing.

The officials for the government and the contractor, the United Network for Organ Sharing, made their comments during a federal court hearing in Atlanta where they were defending themselves against suggestions they’ve been dealing in bad faith and showing a lack of candor in an effort to rush out the change.

“We regret sincerely any misunderstanding,” Michael Drezner, a U.S. Department of Justice lawyer representing Health and Human Services, told U.S. District Judge Amy Totenberg. “There was never any intent to evade a court order,” echoed Sara Anderson Frey, a lawyer for UNOS.

What got them in hot water was their response last week to an order from Totenberg. After she directed the government and UNOS last week to stop the rollout that they had just started, they told her they were in compliance with her order — because the rollout was complete and there was now nothing to stop.

They added that reverting to the original system would take four weeks.

She responded with an order to show up in Atlanta on Monday and explain why they shouldn’t be cited with contempt of court. After that, they said it would take not four weeks but one.

“I think it was a violation of the order, but I’m not going to impose sanctions at this point,” Totenberg said, provided they act in good faith and maintain the “fix it” mentality. “I appreciate the energy and resources dedicated … I appreciate the remorse expressed.”

Totenberg added a warning in her signed order summing up the hearing: “The Defendants’ detour this past week was costly, disruptive, and unfortunate — and should not be repeated.”

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