美国国家公共电台 NPR Searching For A Fairer Way To Distribute Donor Livers（在线收听）

DAVID GREENE, HOST:

The nation's organ transplant network is proposing a change in how livers are made available. The idea is to make the system more equitable, but some are worried that this change would make things less fair for some people, and we have more now from NPR health correspondent Rob Stein.

ROB STEIN, BYLINE: Himanshu Patel is 39 and lives in Waycross, Ga. He ran a convenience store until his liver started failing.

HIMANSHU PATEL: And when I went in the hospital, they told me that you will need a liver transplant. Without the liver transplant, you might not survive.

STEIN: So Patel is anxiously waiting for a phone call to find out if his doctors found a liver for him. So is Piper Su. She's also 39 but lives about 700 miles north, in Alexandria, Va. She's still working as a lawyer, but it's getting harder.

PIPER SU: I tend to get very tired. Oftentimes, I'll have sharp pains in my abdomen from, you know, sort of my - my liver voicing its displeasure. And then, you know, I've developed a condition in my legs, which sometimes they retain fluid, which can be very painful.

STEIN: Patel and Su are among more than 16,000 Americans waiting for a liver transplant, but only about 7,000 livers are donated each year. So their odds aren't great. And Julie Heimbach of the Mayo Clinic says their chances depend a lot on where they live.

JULIE HEIMBACH: Some areas of the country, patients have to wait a lot longer than in other areas. They have to get much sicker before they can access liver transplant, depending on where they live.

STEIN: The reason is complicated. Part of it is that more organs become available for transplants in some places than others for lots of reasons. There are more car accidents, more deaths from strokes.

HEIMBACH: The heroin epidemic has actually led to a lot of organ donors because people become - you know, overdose. They stop breathing. They become brain-dead. And certain areas of the country have more or less of that particular problem.

STEIN: So Heimbach helped come up with a new way to distribute livers. Right now the sickest patient on the waiting list in each of 11 regions gets the next liver that becomes available in that region. The new system would basically expand access to livers to patients within 150 nautical miles from wherever the liver is donated.

HEIMBACH: And whether they're in or out of the region, as long as they're in that 150-mile circle they would be able to access that donor.

STEIN: But the plan is raising a lot of concerns.

RAYMOND LYNCH: This is life-and-death stuff for real people.

STEIN: Raymond Lynch is a transplant surgeon at Emory University in Atlanta.

LYNCH: It's important to know that when you export a liver, you import a death. So if you move an organ from one place to another, you've left a hole in that original place, and that hole is going to turn into a death because now somebody in that original place doesn't have an organ transplant.

STEIN: And Lynch argues that the new plan would tend to shift too many livers from less affluent, rural areas to richer, urban areas.

LYNCH: We would be hurting those people who are most vulnerable in the U.S. - minorities, people with reduced income, people with reduced access to primary care physicians, people who live in rural locations. All those people already do worse.

STEIN: Julie Heimbach, who came up with the new system, disputes the argument that it would cost lives and take organs away from people who need them most.

HEIMBACH: It would not be less fair. It would be more fair. It's not one-way sharing where the livers are being taken to one particular part of the country. It's a broader sharing.

STEIN: When you ask the patients what they think about all this, predictably, their perspective depends on where they live. Piper Su, who lives in Alexandria, Va., where livers are scarce, has been traveling around the country to get listed in as many places as she can.

SU: It's been a bit of an odyssey, and I think the best move for everyone involved is to try to move towards, you know, the most fair system possible that gets organs to the people who need them the most quickly.

STEIN: But Himanshu Patel, who lives in Waycross, Ga., where livers are more available, is worried about having to wait longer.

PATEL: They tell me that I have to wait another six months or something like that then that might put me in the worries that, like, I don't know if I'm going to make it for six months or not.

STEIN: The public has until October 2nd to tell the United Network for Organ Sharing what it thinks about this proposal. Rob Stein, NPR News.