Ruling deals blow to Georgia liver transplant hospitals, patients

Those who control transplants in the United States are planning to address a decades-old geographic disparity in liver allocation. The plan would alter how the precious organs are distributed and could shift hundreds of them across state and regional borders. (The Washington Post)

Georgia liver patients may see fewer livers and organs of lower quality available for transplant within weeks following a significant legal ruling over how the U.S. allocates donated livers.

There are not enough liver donors to supply all the patients who need them, and different regions of the country fight over whether the government is fairly distributing the scarce livers available. The federal government has proposed a change to the distribution system that it says would be fairer, but the likely losers would be states including Georgia. They sued.

The change, the federal government says, would give the sickest patients the first shot at livers, loosening the geographic barriers that often kept the organs much closer to wherever they were donated.

The new system was placed on hold while the suit was working its way through the legal process, but a federal judge lifted that hold Thursday.

As an immediate matter the Georgia and Midwestern hospitals that filed the suit can request a stay; as of Thursday night there was no word of one yet. People associated with the case said they were still reviewing the 100-page order. Longer term, the case is still ongoing, and the losers can appeal.

But the judge, U.S. District Court Judge Amy Totenberg in Atlanta, ruled that the Georgia plaintiffs did not have a substantial likelihood of prevailing in the end. She called the case “wrenching.”

The contractor that manages the liver distribution system said it would start the redistribution as soon as it could complete the necessary computer programming and give proper notice to the parties involved.

A spokesman for Piedmont Healthcare said Thursday that the health system was still digesting the ruling. Piedmont Healthcare, Emory University Hospital and other transplant centers in the South and Midwest are likely to lose out in the change of systems.

An attorney for patients in California, Massachusetts and New York hailed the new policy.

“The new liver allocation policy will benefit all liver waitlist candidates and we are pleased to be a driving force in bringing equitable organ allocation to patients across the country,” the lawyer, Motty Shulman, said in a written statement. “The court once again refused to enjoin the new policy and we look forward to the improved policy going into effect as soon as possible.”

The federal government and its contractor, the United Network for Organ Sharing, believe that the change they proposed will send the most livers to the sickest people, saving lives. The states that will lose out disagree. They say the government and UNOS didn’t use all the correct measures in their analysis in identifying the sickest patients, and that in fact patients with poor health care access are likely to lose out even more under the new system.

Totenberg said it was not up to her to decide which system was best, only whether the government had followed the law in adopting it. She found that it had.

That’s in spite of her criticism in this and previous rulings of the dealings of the government and its contractor. In Thursday’s ruling she called their candor into question, saying she harbored concerns about whether they “may have given an incomplete picture regarding factual and legal issues” to the appeals court.

Totenberg concluded by noting that the organizations still have the opportunity to study whether the change works and further improve, and she suggested that they do what they can to make the transition easy.

Explore MORE AJC COVERAGE: The liver transplant proposal and its possible consequences

In Other News