The United Network for Organ Sharing, a group that decides which patients receive life-saving organ transplants in the United States, has reinstated a policy that gives transplant centers first dibs on donated livers in their communities.
The decision comes amid a long and winding legal battle involving that group, which is a nonprofit organization that's under contract with the U.S. Department of Health and Human Services, patients and major transplant centers.
At issue: There are far more people on the waiting lists for organs than there are organs available for donation. About 13,250 are on the list to receive a liver, according to UNOS. But in 2018, just 8,250 livers were transplanted.
Historically, transplant centers received organs donated in their surrounding communities. But opponents of that policy said that it wasn't favorable to areas with higher demand and less supply. Patients in New York filed a lawsuit claiming UNOS's policy left them waiting longer for the liver donations they desperately needed, while people with less-severe diseases were receiving livers in other parts of the country.
In response, the group adopted a new policy, expanding the area in which a liver could be donated to 500 nautical miles from the donor. But some transplant centers balked at the new policy.
"In fact what happens is, more people die," said Dr. Seth Karp, director of the transplant center at the Vanderbilt University Medical Center in Nashville, Tennessee. Karp explained that traveling farther for a liver can lead to poor outcomes. He says his transplant team aims to get a liver within six to 10 hours, and every additional hour on top of that starts to compromise the quality of the liver.
"Getting the organs from one place to another is not trivial, it's hard to do," Karp said. "It takes time, it takes resources and the complexity that that adds leads to increased discarded organs."
When UNOS announced its new policy, some transplant centers, including those in Georgia, Kansas, Michigan and Missouri, sued.
But last week, a federal court judge ordered that the policy be halted, and the group said it would reinstate the original distribution policy.
On Thursday, UNOS posted a message on its website stating that liver transplants would continue uninterrupted: "UNOS wants to reassure the donation and transplant community that despite the legal proceedings underway, donated livers continue to be allocated to patients on the waiting list; there is no disruption to this important work."
The group still aims to implement some kind of new policy to expand access to organs. "It's easier to transplant the organs than it once was," Brian Shepard, CEO of UNOS, told NBC News. "We think the system should take advantage of that and transplant candidates who are the sickest, regardless of where they live."
Meanwhile, thousands of people in need of a new liver continue to wait. Tamsin Skeels, 48, of Charlotte, North Carolina, is one of them.
Skeels, who has end-stage liver failure, is on the list to receive a liver at the Duke Transplant Center, just a two and a half hour drive away. She was an alternate once for a donated liver, but did not receive it.
Despite her condition, Skeels expressed only gratitude. "That first recipient was first for a reason. It was somebody who needed it as much as I did, even more so," she told NBC News.
While UNOS and transplant centers try to work out the best methods of distributing organs, Karp says efforts to increase organ donation in general would make a significant impact.
"In Tennessee, we have one of the best organ donation infrastructures in the country," Karp said. "If a place like New York improved its donation just to what Philadelphia does, it could get another 1,000 to 1,500 organs."
"If we put our energies into getting more organs, we could actually solve the organ crisis for liver transplants."