Chapter 6.C (or 4.C)  Allocation of Organs

Introductory Material

While patients with AIDS are not candidates for an organ transplant, patients whose HIV-infection has responded to treatment may be able to receive organ transplants.  See Michelle E. Roland & Diane V. Havlir, Responding to Organ Failure in HIV-Infected Patients, 348 New Eng. J. Med. 2279 (2003).

UNOS Liver Allocation Policy

For an excerpted version of the current liver allocation policy, see UNOS liver allocation policy.

Although the use of MELD scores for liver allocation was designed to bring more objectivity to the allocation process, disparities exist between patients on the wait lists of organ procurement organizations (OPOs) with short waiting lists and patients on the wait lists of OPOs with long waiting lists.  Patients in small OPOs are 2.5 times more likely than patients in large OPOs to receive a transplant, and they are much more likely to have a MELD score below 25 (the maximum score is 40).  James F. Trotter and Michael J. Osgood, MELD Scores of Liver Transplant Recipients According to Size of Waiting List, 291 JAMA 1871 (2004).

Criteria for Rationing Organs

Note 2.  Life expectancy may become part of the UNOS kidney allocation policy soon.  See Laura Meckler, More Kidneys For Transplants May Go to Young, Wall St. J., March 10-11, 2007, at A1.

Note 3.  Does a potential recipient of an organ ever enjoy a legal right to the organ?  That question almost was answered in Colavito v. New York Organ Donor Network, Inc., 2006 NY Slip Op 9320 (N.Y. 2006), earlier proceeding at 438 F.3d 214 (2d Cir. 2006).  That case arose after a widow tried to donate a kidney from her deceased husband to the husband's longtime friend.  One of the kidneys was sent to the friend's hospital, but anatomical abnormalities (renal artery aneurysms) made the kidney unsuitable for transplantation.  When the friend's surgeon asked for the second kidney, he was told that it had already been transplanted into another person.  The widow argued that she intended for any donation to be limited to the longtime friend, and there were questions whether the second kidney had in fact been transplanted when the call came from the friend's doctor.  As it turned out, immunological testing demonstrated that the kidneys were not compatible with the friend and could not have been transplanted into him.  For that reason, the New York Court of Appeals did not decide whether a disappointed transplant recipient might have a cause of action under New York public health law for failure to receive the transplant.  The court did conclude that a disappointed transplant recipient is not able to bring a cause of action for conversion

Whether or not potential recipients enjoy legal rights to a transplant, they may have a valid claim if they lose an opportunity for an organ because of a transplant programís malfeasance. Litigation against the liver transplant program at University of California-Irvine precipitated a shutting down of the program by the federal government. A patient sued the program, claiming that it wrongfully denied her an organ on many occasions over a four-year period. In supporting her claim, the patient cited a UNOS document indicating that the transplant program had declined organs offered by UNOS for the woman approximately 40 times. Irvine v. Regents of the University of California, 57 Cal.Rptr.3d 500 (Ct. App. 2007) (reinstating claim and remanding for consideration by the trial court). During its investigation of the program, Medicare found that the program lacked adequate staffing, resulting in a very high level of deaths among patients on the waiting list. Charles Ornstein and Alan Zarembo, Hospital Halts Liver Transplant Program, L.A. Times, Nov. 11, 2005, at A1.



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