Liver transplantation remains a modern miracle for the treatment and cure of patients with advanced liver disease. While the actual surgery is complex and time consuming, the results are excellent. There are two pathways for receiving a new liver. The fastest is called living related donation. Living related donation involves one person (donor) giving a portion of their liver to another person (recipient). The donor must be the same blood type and approximately the same size as the recipient and the donor must have a healthy liver. Only a small minority of liver transplants are living related donations. Most liver transplants in the U.S. are the result of the death of a donor who has previously agreed to be an organ donor or whose family agrees to organ donation.
At present, the U.S. is divided into 11 regions for organ allotment. In essence, each region keeps its own list meaning that the sickest people in the country are not necessarily the ones who receive the needed organs. There is tremendous geographic variation in deceased donor organ donation across the country. New York and Vermont make up region nine. For example, in region nine in 2016, 327 livers were donated while in region three, the Deep South and Puerto Rico, more than 1,300 livers were donated in the same time period. This makes the most important determinant of a patient receiving a life saving organ not their medical condition but rather the zip code in which they reside. One would ask, “Why are there so many more liver donors in the South than in the Northeast?”
The Deep South is the center of America’s stroke belt due to significantly higher rates of obesity, diabetes and hypertension. These conditions lead to an increased number of fatal strokes and a greater supply of donors. In addition, many Southern states have higher death rates from motor vehicle accidents leading to an expanded donor pool.
In the U.S., there are 143 liver transplant centers that performed 7,841 deceased donor liver transplants in 2016. Currently, there are more than 14,000 people on waiting lists for a new liver and more than 1,000 die each year while waiting.
The Organ Procurement and Transplantation Network approved a new policy to more equitably distribute livers across the country. The new policy extends the area in which a liver can be offered by drawing a 150 nautical mile circle around donor hospitals, with some exceptions. While this new policy does not equalize organ allotment based upon medical need, it does increase the geographic area that a given region may receive organs from. This is good news for New York as it will mean more usable livers for our patients and more transplants. As New York expands its potential for performing liver transplantation, this new policy should help, especially the currently underserved liver population on Long Island, where as of now, no liver transplant programs operate.