美国国家公共电台 NPR New Organ Transplant Rules Mean Livers Ship To Sickest Patients Not Nearest（在线收听）

AUDIE CORNISH, HOST:

A new system for allocating donated livers to sick patients went into effect this morning. The intent is to make organ transplants more fair nationwide, but transplant centers in the South and Midwest are fighting it. Blake Farmer of member station WPLN in Nashville explains why.

BLAKE FARMER, BYLINE: Karen Wells wheeled her husband into the ER at Vanderbilt University Medical Center last year, praying for a miracle. He was so jaundiced he was almost unrecognizable.

KAREN WELLS: He was dark - very dark. I mean, there was no whites to his eyes. They were orange.

FARMER: The doctors said it was time to make funeral arrangements. His body was rejecting his first liver transplant.

K. WELLS: It's a miracle, honestly, to get two...

FARMER: Two livers for one patient. It was a long shot, but fortunately, Wells lived in Tennessee, where the waiting list was shorter than on the East and West coasts. For decades, livers were donated to patients nearby, no more than a state or two away. But under the new rule, a liver must be matched with the most critical patient within 500 miles. That means a liver donated in Nashville could end up in Chicago. Brian Shepard leads the agency that oversees organ sharing. He says the new rules should save lives.

BRIAN SHEPARD: Targeting the livers towards those folks who are really the most critically ill will result in fewer people dying on the waiting list.

FARMER: But that seems unfair to transplant centers in the South and Midwest, where organ donation rates are higher. More people there sign up to donate, and they also die more often in ways that allow their organs to be used, like from a stroke. The old regional discrepancies meant some patients could game the system. When he needed a liver, Apple founder Steve Jobs even bought a house in Memphis.

SANDY FLORMAN: He didn't do anything illegal, but he took advantage of a system because he was able to, financially.

FARMER: Sandy Florman is transplant director at Mount Sinai Hospital in New York City, with one of the longest waiting lists in the country.

FLORMAN: The problem is it's turned into a turf battle. These are very profitable hospitals, and people are afraid that their programs will not do well.

FARMER: A dozen transplant centers sued to stop the policy from taking effect, including Emory, University of Michigan and Vanderbilt. But all they got was a few extra weeks. Seth Karp is Vanderbilt's transplant director. He predicts unexpected delays because many more hospitals will now have to weigh in when a liver becomes available.

SETH KARP: The more complex the distribution scheme is, the more chances you have of not using the liver.

FARMER: Karp estimates Vanderbilt will perform 20% fewer transplants and may have to downsize. And he worries about smaller centers.

KARP: The - if the program in Mississippi closes, if the program in Iowa closes because of this, that's a real national public health problem.

FARMER: I asked Jeffrey Wells, the patient who was near death at Vanderbilt last year, what he thought. He did get that second liver transplant, benefiting from the shorter waiting list.

JEFFREY WELLS: And I'm eternally grateful.

FARMER: Wells actually supports the new rule.

J. WELLS: I mean, I'm like this. When a person decides to be a donor, I don't feel like they're becoming a donor to save one particular person's life.

FARMER: But the transplant centers that sued say they'll keep up their fight in the courts. For NPR News, I'm Blake Farmer in Nashville.

CORNISH: And this story is part of a reporting partnership between NPR, WPLN and Kaiser Health News.