PITTSBURGH Veterans Affairs raises questions about transplants

UPMC officials note that organs don't always suit the top candidates on a list.
PITTSBURGH (AP) -- Federal officials have raised concerns that organ transplant candidates at Veterans Affairs hospitals have been wrongly bypassed in favor of patients at the University of Pittsburgh Medical Center.
UPMC officials say patients at the top of waiting lists have been bypassed more frequently than in the past because doctors are now using fattier livers and organs from donors with lower blood pressure that are sometimes better matches for patients lower on the list.
The concern was raised about eight months ago when a surgeon told organ donation coordinators that two livers that were initially offered for VA patients went to patients at UPMC. The surgeon said he didn't think he had received accurate information about donated livers, and as a result, the livers went to UPMC patients when they might have gone to VA patients.
"We've had many complaints about veteran patients being overlooked -- about organs going down to the university for patients who aren't as sick," said Brenda Salvas, manager of the liver and kidney transplant program for the VA in Washington, D.C.
Request for investigation
The Department of Veterans Affairs has asked the United Network for Organ Sharing, the Virginia-based group responsible for the nation's organ donation and transplantation network, to look into the matter. A spokeswoman for the network declined to comment on the issue.
The Office of Inspector General for the VA has requested information from the Pittsburgh VA hospital on the matter but has not opened a formal investigation. The hospital has until Oct. 20 to respond.
Will Cook, program administrator for transplant services at UPMC, told the Pittsburgh Post-Gazette for its Wednesday edition that patients are not being cheated.
"You have to be really, really careful about the matching process -- you have a smaller margin of error, and you have to be much more selective in who you pair that organ with," Cook said. "Sometimes you have to put the liver in a patient other than the first patient listed for that organ."
Notification procedure
A year ago, the Center for Organ Recovery and Education, the local group in Pittsburgh that coordinates organ donations, had agreed to notify surgeons at both UPMC and the VA whenever both programs had patients near the top of the list for a newly donated liver.
UPMC officials asked the center instead to contact one UPMC surgeon, who would then consult with the VA surgeon. Transplant surgeons at the VA Pittsburgh Healthcare System's University Drive division operate at both the VA and UPMC.
The center suspended that practice in February after learning that questions were being raised about organ allocation. Brian Broznick, CORE's executive director, said all parties were consulted and the VA surgeon's complaint "was dispelled to a great degree."
Organ donation coordinators have asked UPMC on six or seven occasions for more information about a transplant decisions. Patients most likely to die without a transplant are ranked higher on the list.
"It's our role to raise the red flag," Broznick said. "When you bypass 30 patients on a list, there has to be some justification for that, and that's what we're asking."
Officials say use of expanded-criteria donors has helped UPMC reverse a 12-year decline in the number of liver transplants performed. The 21 liver transplants last year at the VA were the most performed in a single year at the hospital.