Doctors and patients worry about possible liver transplant changes
Kansas legislators have a plan to make sure organ donations aren’t shipped off to the coasts: Allow residents to specify that their organs must go to Kansans.
Senate Bill 194, which lawmakers discussed in a hearing Tuesday, is intended to ward off new national policies to redistribute organs from areas where donations are more plentiful — such as the Midwest — to areas suffering shortages — such as larger cities.
No other state has passed such a law, and there are questions about whether Kansas has the authority to do it.
But Sen. Barbara Bollier, a Mission Hills Democrat on the health committee that held the hearing, said that because of the federal changes, Kansas probably won’t be the last to consider it.
“I would predict this will happen in a lot of the Midwest states,” Bollier said after the hearing. “They will say, ‘We’re going to try to keep our organs in our area.’”
Bollier, a retired physician, said she supports the bill because when organs travel farther, costs rise and the odds of a successful transplant drop.
The most vocal proponents at Tuesday’s hearing were Kansas patients awaiting transplants and the University of Kansas Hospital, which performs the procedure.
“Due to donor shortages it seems like you have to be near death to get a transplant anymore,” said Candice Seaman, who lives in Waverly, near Emporia, and needs a new liver. “Many people are unaware of the organ situation in this country, and while I have lots of opinions on organ donation, my main focus is just keeping organs local — giving the opportunity to people that are in our state.”
But Sen. Molly Baumgardner, a Louisburg Republican, said Tuesday’s hearing left her with concerns. She said there’s a good chance the bill could be challenged in court if it becomes law, because organ transplants are regulated at the federal level.
It would take years for the bill to go into effect, if it ever does, Baumgardner said, and she didn’t want Kansans who are desperate for a transplant thinking they’re going to get one if the bill passes.
“If this is just one link in a long chain, we need to know that and the public needs to know that,” she said.
She also said logistical questions haven’t been addressed, like whether Kansas residents who have to go to an out-of-state hospital because of the complexity of their case would still be eligible for one of the Kansas-designated organs.
Or whether somebody who lives in another state but is coming to Kansas for a transplant would be eligible.
“When we think of our (Kansas City) metro area, we have a whole lot of folks in Missouri who go to KU Med Center,” Baumgardner said.
The wording of the bill suggests those decisions could be left up to donors. It instructs the Kansas Department of Health and Environment to allow Kansans who register to be organ donors to put conditions on who can receive their organs, as long as those conditions don’t violate laws that prevent discrimination based on things like race, religion and national origin.
The agency would have until July 2020 to figure out how to do that.
Baumgardner said there are also serious ethical questions about potentially allowing people in other states to die in order to reserve organs for people in Kansas who may not be as sick.
“We did not even broach those issues,” Baumgardner said.
Midwest and Southern states tend to have higher organ donation rates than coastal states. A lawsuit brought by patients waiting for livers in New York, California and Massachusetts threatens to upend the current state-based regional system into one in which organs might routinely travel 500 miles for transplant — and even further in special cases.
The Organ Procurement and Transplantation Network, the federal contractor that coordinates donations and transplants, has already approved a more national system for livers, which is set to take effect at the end of April.
That decision has drawn intense criticism from Republican U.S. Sens. Roy Blunt of Missouri and Jerry Moran of Kansas.
Anne Paschke, a spokeswoman for the transplant network, said the new model will save lives by steering organs toward the patients who need them the most, with less regard to boundaries like state lines.
Polls have shown most donor families don’t care whether their loved ones’ organs stay in state or not, she said.
“In general, donor families really want to know their tragedy has turned into something that is life-saving and life-altering for other people and that good came from their tragedy,” Paschke said.
But transplant surgeon Timothy Schmitt, representing the University of Kansas Hospital, told legislators that the bill would assert Kansans’ rights to do what they want with their organs.
Organs are a gift, he said, “not a national resource.”
“If individuals feel that it’s important to help their neighbor, their community, fellow Kansans on the wait list, we want to make that possible,” Schmitt said.
Schmitt said other parts of the country should try to emulate the success of Kansas City’s official organ procurement organization, as well as local groups like Gift of Life, and convince more people to register as donors, rather than trying to take organs from elsewhere.
KU and other transplant centers in the Midwest have benefited from high donation rates in their areas and have campaigned against the new national organ allocation policies.
Michael Borkon, the surgical director for heart transplants at Saint Luke’s Health System, said that as of last October, hearts are being distributed similar to the way livers soon will be, and that change has had severe consequences.
Of the 13 heart transplants Saint Luke’s has done since then, all came from donors outside of Kansas City, he said, compared to about half before the change. But at the same time, most hearts donated locally went elsewhere.
“Surgeons are away from KC for up to eight hours to retrieve (hearts),” Borkon said via email. “Problems with logistics, planes, pilots and other teams have become a nightmare, and the acquisition charges related to travel have nearly doubled. Our local programs have suffered, and we will do less transplants as the majority of donor hearts are leaving the area.”