A four-month Pittsburgh Tribune-Review investigation found, hundreds of patients each year undergo liver transplants when they don't need them, and possibly never will. One in 10 of those patients die when they could have lived longer without the transplant. The rest - all at the rock-bottom of waiting lists - must resign themselves to an early battle with the burdensome risks of anti-rejection drugs and complications that can follow: infections, cancers, kidney damage, and high blood sugar.
What's worse, a third of those patients get the worst available livers, organs sometimes rejected by surgeons for thousands of sicker patients across the country. The University of Pittsburgh Medical Center and three other centers head the list of hospitals doing such surgeries.The founding fathers of organ transplantation - including pioneer Dr. Thomas E. Starzl at UPMC - warned more than a decade ago against transplanting livers into the least sick. Starzl and many others haven't changed their minds. "It is undoubtedly true that there are transplants being done that shouldn't be done," said Starzl, 81, and just now moving toward retirement at UPMC.
The Trib investigation found:
• Despite a federal rule designed to limit the number of liver transplants in patients who aren't critically ill, four of the nation's 128 programs have done half of the 846 such transplants since 2005. The programs, by volume of transplants, are Clarian Health in Indianapolis, Pittsburgh's UPMC, Mayo Clinic in Jacksonville and Strong Memorial Hospital in Rochester, N.Y. Most other centers do not give livers to less-critically ill patients, except in rare cases.
• Transplants among least ill patients mean big money for medical centers facing increased competition. By doing transplants no one else will do, centers tap into a pool of some 8,500 patients worth an estimated $4 billion in potential charges. They typically get paid the same, no matter how sick the patients are.
• No federal rules exist on the use of marginal or inferior livers for transplantation. Individual surgeons decide whether an organ is suitable. However, when an organ comes from a high-risk donor, physicians are required by federal regulation to make that clear to the patient.
• Liver transplant programs sometimes bypass the sickest patients because their reduced survival odds can hurt overall center success rates.
• Of the 16,000 people on the national liver transplant waiting list, only about 3,400 are so sick that having a transplant would increase their odds of surviving.
• People at the bottom of waiting lists rarely get sicker quickly. Only five percent of the 5,800 people in the lowest segment of the list get so sick within a year that they absolutely need a transplant.