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    LIVER TRANSPLANTS
    Beacons of hope

    Responding to urgent need

    UNOS also has revised U.S. liver transplant policy on the allocation of donated cadaver livers. The policy determines the order in which donated livers are offered to people on the waiting list.

    UNOS categorizes liver transplant candidates into one of four groups, depending on their medical urgency. People with the most urgent need, often with a life expectancy of less than 1 week, are considered Status 1. Status 2a includes the next most urgent group, followed by Status 2B and Status 3.

    Previously, donated livers were first offered to Status 1 people in the local area where the organ was donated. If no match was found, the liver would then be offered to Status 2 or 3 people in the local area. If no match was found locally, the organ would then be offered in order of urgency to people in the larger UNOS region - there are 11 regions nationwide.

    Under the revised liver allocation guidelines, a donated liver will still be offered first to local Status 1 people. However, if there is no match, it now will be offered to Status 1 people in the larger UNOS region before being offered locally to any Status 2 or 3 people. The new policy is aimed at offering livers to people who are at greatest risk of imminent death.

    Bob Spieldenner, a spokesman for UNOS, has a caution about the revised policy. He says that while the new policy is an important change, it may actually increase the total number of deaths. "Status 1 patients are the highest risk group," "They are more likely to reject a transplant, so the number of repeat transplants will likely increase, thus reducing the total number of livers available."

    Status 1 patients also are less likely to survive a transplant, so overall survival rates will likely fall slightly among liver recipients.

    The revised organ allocation policy is expected to increase the number of transplants performed for Status 1 patients by almost 80 percent, and to cut the waiting period for these patients in half.

    New approaches for HCV-positive people

    An estimated 4 million people in the United States are currently infected with HCV, and 30,000 new cases are diagnosed each year. According to Spieldenner, some experts predict that the waiting list for a liver will triple because of HCV.

    HCV-infected livers are routinely discarded, but new evidence suggests that they may offer a viable option and expand the donor pool for those already infected with HCV.

    A study published in the July 1999 issue of the journal Gastroenterology reported that the transplantation of HCV-positive livers into people already infected with the virus did not affect transplant outcome. Both 1-year and 5-year survival rates were comparable between HCV-positive people who received infected livers and those who received healthy livers.



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