Emory Report

November 9, 1998

 Volume 51, No. 11

Moratorium halts changes to organ allocation until May

Georgia transplant candidates currently waiting for a liver no longer have to worry about proposed changes to the current organ allocation policy that could add 86 days to their wait (Emory Report, Sept. 14). As part of the spending bill signed into law on Oct. 21 by President Bill Clinton, a moratorium delays enactment of changes proposed by the U.S. Department of Health and Human Services (HHS) for one year and requires a study of organ allocation policies.

"This is truly a victory for Georgia transplant patients [and] potential donors who are inspired by the idea that their organs may go to a fellow Georgian," said Jennie Perryman, director of the Center for Transplantation at Emory Hospital. Emory and Egleston hospitals are the only facilities in Georgia that offer adult and pediatric liver transplants.

Since the liver transplant program began in 1987, 537 adult livers have been transplanted here. "Not only does the moratorium allow at least one more year with a system that has worked for Georgians, but the study that will be completed May 1, 1999, may uncover ways to make it work even better," Perryman said.

The proposed government changes started with allocation of donated livers. "But," Perryman added, "eventually it would have effected allocation of other organs." Currently, donations from Georgians are made available to the sickest state residents first, then to others in the Southeast before being offered to patients across the country.

Proponents of the current system believe it has an impact on the high organ donation rate in Georgia and the success of transplants because less time is lost in transportation of transplant candidates or the organs themselves. The average wait for patients on Emory's liver transplant list is six to eight months.

On April 2 HHS published a rule that discarded the regional system and dictated a national waiting list for livers, with the organs going to the sickest patients first-regardless of geographic separation from the donor.

"The problem with the HHS rule is that geographic separation between donor and recipient can cause ineffective use of organs, which are already in short supply," said Thomas Heffron, director of Emory's adult liver transplant program and the pediatric program at Egleston. "A donated liver is only good for 12 hours. With each hour the chances of a successful transplant decrease," he said.

Heffron believes a national waiting list would create a higher complication rate, higher death rates after transplant, higher costs and cause more damage to precious organs that would have to be stored for longer periods of time while traveling greater distances.

"It is a life or death issue for me," said Athens resident Marjorie Calhoun, a 63-year-old liver transplant candidate who has been on the waiting list since March. "Who knows how sick I may get before a matching donor is found. Adding three months to that wait reduces the chances of a successful transplant."

Georgia representatives in the U.S. House and Senate fought hard for the state's patients, said Steve Moye, associate vice president for government and community affairs. "If Newt Gingrich had not made this issue a top priority, this compromise would never have become a reality," he said. Rep. John Lewis also did much to gain support among his House colleagues, Moye said.

--Diana Lewis

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