- Associated Press - Friday, August 1, 2014

KANSAS CITY, Kansas (AP) - When Gil Alicea was diagnosed with liver cancer and told he needed an organ transplant, doctors gave him some blunt advice: “Get … out of New York.”

Alicea needed a liver fast. But the wait for an organ can be excruciatingly long on the East Coast. So in 2010, Alicea put himself on the wait list at the University of Kansas Hospital, where patients often receive livers quicker, before their health goes into serious decline.

He got the call from KU in just eight weeks. A chartered flight made it to Kansas City just in time for the transplant operation. “He woke up literally singing,” wife Barbara Zitwer recalls.

But the cruel reality for most people with failing livers - those who can’t afford to charter a plane - is that your chances of survival can depend on where you live.

The stark disparities among regions of the country, where some wait months while others, if they survive, wait years for a liver, has kept a national debate simmering over how best to give all patients a more equal chance.

That debate appears ready to boil, the Kansas City Star reported (http://bit.ly/1k0Qp9m ).

A committee report by two organizations responsible for managing the nation’s transplant system has been circulating through the transplant community this summer. It suggests ways to equalize access to donor livers across the country.

Redesigning the distribution system would mean more donor livers would end up being flown to distant transplant hospitals and patients on average would be somewhat sicker when those livers were transplanted.

But overall, the changes would save more than 550 lives over five years.

The report, which could lead to proposed policy changes early next year, is being applauded by many in the transplant community. But it’s raising red flags at some transplant programs, like KU’s, that are doing well under the current system.

“We know we have supply and demand issues. We know we can’t keep everyone alive. But this is just going to move organs around,” said Richard Gilroy, medical director of liver transplantation at KU. “Ultimately, in five years you’re not going to change anything.”

As with other organs sought for transplantation, demand for livers far outstrips the supply. About 12,000 patients are added to liver transplant waiting lists each year. The number of donors has remained fairly constant at roughly 7,000 per year.

KU Hospital’s transplant program benefits from the current system, which generally offers donor livers first to transplant hospitals in the region where the organs were collected. And the number of people who donate their organs varies drastically by geography.

People in KU’s region are more likely to become donors than are people in any other part of the country. That helps KU Hospital boast an average wait time for a liver of less than six months. Nationally, patients average a 14-month wait, according to the hospital.

The changes to the system that are under discussion would broaden access to livers for more hospitals. Instead of the current system of 11 regions for distributing livers, a system of eight or even four mega-regions could be created, with sicker patients receiving priority. Doing that would spread the organs around to areas that previously got fewer.

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