Liver battle pits Midwest, South against California, New York

A heated redistricting battle has gripped the nation’s heartland this fall, but instead of votes, the debate has centered on livers.

Dozens of lawmakers from the Midwest and South are lashing out against the national organ network’s plan to redraw the map that governs its collection and distribution of livers. 

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Under the “redistricting” plan, states with larger supplies of livers — such as Kansas and Tennessee — would share their donations with states like California or New York, where organ donation is less common.

The United Network for Organ Sharing, a private nonprofit that’s contracted by the federal government, has argued that the plan would “increase equity to access” for people across the country.

But critics of the plan have blasted it as “political gerrymandering” that would punish thousands of people in donor-rich areas. Some worried their home states will become “organ farms” for states along the coast.

A bipartisan group of 52 members of Congress signed a letter Friday condemning the plan, which will be discussed by the national organ-sharing network Tuesday. Lawmakers from Texas, Tennessee, Kansas, Mississippi, Iowa, Ohio, Wisconsin and Indiana all signed the letter.

Rep. Kevin YoderKevin YoderLawmakers wrestle with cellphone tracking for missing persons How Congress should proceed on the Kelsey Smith Act Overnight Cybersecurity: FBI won't tell Apple how it hacked iPhone MORE, (R-Kan.), who spearheaded the effort, said in a statement that the solution to the nation’s organ shortage isn’t shipping them out of the Midwest or South.

“[The United Network for Organ Sharing] should not adopt proposals that punish successful programs and decrease access to organs where donation rates are highest,” Yoder wrote in a statement Monday. Instead, he said, officials should increase donations in areas of the country “where disparities in wait times are the greatest.”

The rates of organ donation vary widely across geographic regions. Rates are highest in the Southeast and Midwest, which also experienced the nation’s highest death rates.

That disparity can lead to vastly different outcomes for patients. Death rates for people awaiting liver transplants range from 14 percent to 82 percent depending on their state, according to a 2013 report by the American Journal of Transplantation.

Eleven Georgia congressman raised alarm about the remapping plan in April. In a letter to the Department of Health and Human Services (HHS), the lawmakers warned that the plan “would single out the state of Georgia, making it the only southern state in a region comprised of northeastern states.”

The new boundaries would hike up the average travel time for a liver to eight hours from five hours, which Georgia lawmakers cautioned would increase risks and transportation costs for each transplant.

But David Mulligan, chairman of the organ-sharing network’s liver committee, said the plan would ensure that people with the greatest need are first to receive new organs. Livers only last outside the body about 12 hours before a transplant.

If people with less-urgent needs “just wait a little longer, they’ll be a hero and literally save the life of someone who doesn’t have that extra day,” Mulligan told the Hill. Mulligan, a liver transplant surgeon, is also the chief of transplantation at Yale University. 

About 15,600 people are currently waiting for a liver transplant, including 3,000 in California and 1,300 in New York, according to HHS data. There are just 129 people on the wait-list in Kansas and 252 in Georgia.

The ethics of organ transplants grabbed national attention in 2009 when then-Apple CEO Steve Jobs traveled to Tennessee from California to receive a liver transplant, raising concerns that he had “cut the line.”

When choosing transplant recipients, health officials already consider medical urgency as well as geographic distribution. The organ network is currently split into 11 districts, and could soon be turned into as few as four. 

Nearly 50 transplant doctors, mostly in the Southeast and Midwest, also oppose the plan. The group sent a sharply worded letter to the HHS this summer that describes the plan as “the most drastic change in liver allocation ever.”

Mulligan, who will lead Tuesday’s discussion with more than a dozen other transplant doctors, stressed that the group is far from making a final decision. He added that each day the group continues to weigh the options, people across the country die awaiting transplants. 

He fought back against criticism from some Midwestern and Southern officials that the organization should instead focus on driving up donation rates in states along the coast. Donation rates in those areas have remained flat for about a decade.

“It’s kind of nice to say, 'Oh, all we’ve got to do is make them donate more in the Northeast or Northwest.' But I don’t know how we’re going to do more than what we’re already doing,” Mulligan said.