PITTSBURGH, June 16, 1998 — Children awaiting liver transplantation are especially disadvantaged by the current allocation system, which favors local use of donated organs and often prevents children from receiving precious organs from pediatric donors, says a surgeon from the University of Pittsburgh, citing data from the United Network for Organ Sharing (UNOS).
The transplant system is operated under federal contract by UNOS. Current UNOS allocation policy preferentially allows organs donated for transplantation to be used within the local area served by an organ procurement organization (OPO) even if there may be a sicker patient elsewhere in the United States. Because inequities exist with such a system, the U.S. Department of Health and Human Services (HHS) announced a new regulation that requires UNOS to develop different policies that give greater emphasis to medical urgency than geography. The regulation, which UNOS opposes, is now the subject of a congressional hearing Thursday, June 18.
Jorge Reyes, M.D., FACS, FAAP, who is associate professor of surgery and director of pediatric transplantation at the University of Pittsburgh Thomas E. Starzl Transplantation Institute and Children’s Hospital of Pittsburgh, supports the regulation and compels UNOS to reform policy in order to address the plight of children.
"In areas where an OPO does not serve a pediatric liver transplant program, there is often reluctance to procure organs from pediatric donors or to share outside the service area adult livers that could be surgically reduced and transplanted into children sicker than local patients," says Dr. Reyes.
Data from the UNOS scientific registry recently presented by researchers from the Medical University of South Carolina and UNOS at the Twenty-Ninth Annual American Pediatric Surgical Association meeting May 12, raise serious concerns about the current system, says Dr. Reyes, who shared these in a letter to HHS Secretary Donna Shalala.
Following are some of Dr. Reyes’s observations based on the paper that looked at UNOS registry data from 1990-1996:
Pediatric donations have increased between 1990 and 1996, from 800 to 936, but not at the same pace as the pediatric waiting list, which has nearly doubled from 768 to 1,285.
Despite an increase in pediatric donors, children needing those organs are being bypassed, more so in recent years than in 1990, just prior to the allocation system becoming more geographically based.
In response to the limited number of pediatric livers being allocated regionally and nationally, surgeons have resorted to other life-saving procedures, such as living-related transplantation and transplantation using reduced or split cadaveric adult livers. In 1990, 85.5 percent of pediatric transplants used whole organs from pediatric donors, compared to 70.8 percent in 1996.
There were 936 pediatric (under the age of 17) donors in 1996, but only 306 pediatric patients received organs from those donors. Some 156 other children were transplanted using reduced adult livers or segments donated by a living parent; 75 children under the age of 17 died on the waiting list that year.
As the transplant community deliberates on specific allocation policies that meet the goals outlined in the federal regulation, Dr. Reyes and others from the University of Pittsburgh believe special consideration should be made so that barriers are removed that impede saving the lives of pediatric patients.
Pitt’s chief of transplantation, John Fung, M.D., Ph.D., will testify at Thursday’s joint hearing of the Senate Committee on Labor and Human Resources; Subcommittee on Public Health and Safety, and the House Commerce Committee’s Subcommittee on Health and the Environment.