New Organ Allocation Policy Shortens Wait Time to Liver Transplant
Recent changes in the national organ allocation system led to a dramatic increase in liver transplants at Cincinnati Children’s. In a typical year, the Liver Transplant Program averages 25 liver transplants. In 2020, that number was 39. These changes resulted in patients being transplanted faster on average and spending less time on the waitlist. For instance, the median wait time for patients listed in 2017 through 2018 was 118 days. For patients listed in 2019 and 2020, the median wait time was 88 days.
United Network for Organ Sharing (UNOS) changed its system in February 2020. Now, instead of being limited to donated organs in Ohio, Indiana and Kentucky, Cincinnati Children’s can receive organs from any hospital within a 500-nautical-mile radius. According to the UNOS website, the new “circle-based system” is intended to improve the process of matching lifesaving organs to candidates in greatest need of them.
In addition, UNOS began prioritizing pediatric patients on the waitlist, especially when organs from deceased pediatric donors became available.
“Other children’s hospitals have the same advantage in regard to prioritizing pediatric patients, but UNOS’s new system created a unique zonal distribution around Cincinnati,” says Greg Tiao, MD, director of the Division of General and Thoracic Surgery and surgical director of liver transplantation at Cincinnati Children’s. “We are one of only a few centers providing transplants in our defined zone, which encompasses most of the Midwest and extends well into the south and north to Michigan. The new policy improved our access to high-quality organs and increased our offer rate significantly.”
The effect of the policy changes at Cincinnati Children’s was immediate, says Alexander Miethke, MD, medical director of the Liver Transplant Center. “These changes substantially shortened the waiting time for children on the waiting list,” says Miethke. “Our patients were getting matched with organs from as far away as South Carolina and Oklahoma, something that had never happened before. In a typical year, we might get 75 organ offers. From March to May 2020, we had 280.”
The increase in liver transplants created logistical challenges related to staffing and scheduling, and frequently changing coronavirus (COVID-19) restrictions added another layer of complexity.
“These were sometimes difficult conditions, but our transplant teams came together with remarkable spirit and dedication to accomplish our primary goal of maintaining access to liver transplantation and safety for our patients,” Miethke says. “The new UNOS system also positively impacted children and adolescents waiting for a combined transplant of liver with heart or kidney. We anticipate that this year will be even busier than last.”
