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Getting a liver transplant could get easier in parts of the US

It's harder to get an organ transplant in California and New York than in Washington state or South Carolina. A plan to redraw the organ donation map may change that.
Photo by Molly Riley/AP

More than 120,000 people across the US are waiting for an organ donation, and their odds of actually getting one depend largely on where they live. That could soon change: the entity that oversees organ transplants in the US — the United Network for Organ Sharing (UNOS) — on Monday proposed tweaks to the system to make organs more fairly accessible across the country.

UNOS proposed a new map that will shift the country's geographic transplant regions, with the update focused first on liver transplants. Redrawing the lines of the map would balance out supply differences so that people living in more dense areas with longer waitlists would no longer face greater challenges getting an organ simply because of geography.


"We want to make sure we give everyone a fair opportunity to get a liver transplant," Dr. Ryutaro Hirose, chairman of the liver transplant committee at UNOS, said in a statement announcing the proposal. "It's pretty much long overdue."

Hirose said the new geographic parameters for liver donation regions would ensure that the map better matches organ supply and demand.

"There's a huge difference in the risk of death on that waiting list depending on where you live," said Hirose, a transplant surgeon at the University of California, San Francisco. Shifting the boundaries that determine where a liver is offered first "matches better the organ supply and demand."

He said parts of the country have fewer available organs, and higher demand for them, than others. Due to population density and the way the map is drawn, patients in California and New York have a much harder time obtaining a donated organ than people in South Carolina or Washington state.

Currently, the US is divided into 11 regions, comprised of anywhere from two to five states. If someone living in Los Angeles needs a new liver, they will be put on a waitlist of 3,253 people in Region 5, which includes the states of California, Nevada, Arizona, New Mexico, and Utah. Meanwhile, in the region that includes states like Tennessee and Kentucky there are just 888 people waiting for the same organ.

For years these difference have pushed some to relocate to less dense areas, where they can secure a higher spot on a wait list and hope to receive an organ while they are still in reasonably good health.


The starkest example involved Apple co-founder Steve Jobs, who put himself on a waitlist for a new liver in his home state of California, but he also registered with a hospital in Tennessee. In 2009, he finally made it to the top of the list at Memphis, Tennessee's Methodist University Hospital Transplant Institute, and the technology entrepreneur underwent a successful transplant. He died nearly three years later from pancreatic cancer.

While relocating geographically for an organ is completely legal, the organ transplant system has been criticized for seemingly giving the wealthy the opportunity to get themselves on multiple waitlists, and thus buying a better chance of receiving an organ.

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In order to be put on a waitlist at a hospital, a patient must undergo medical evaluations and testing that can cost tens of thousands of dollars. If the person wanted to get added to another hospital's waitlist, they would need to go through, and pay for, the testing again. The person must also be able to travel to the hospital in time to receive the organ.

There were nearly 31,000 organ transplants performed last year, more than 7,000 of which were livers. While 2015 saw a record number of transplants, 1,400 people died before they could receive a new liver.

Follow Kayla Ruble on Twitter: @RubleKB