Blacks get transplants sooner in new system

Sicker patients now get liver transplants sooner.

CHICAGO (AP) — Blacks waiting for a liver transplant used to be more likely to die compared with whites. Now they have the same chance of getting a life-saving organ under a nationwide system that puts the sickest patients first, a new study found.

Racial differences disappeared when the old system was scrapped in 2002, according to the federally funded study, the first assessment of how blacks fared after the change.

“By design, we tried to make it race blind. It looks like we did,” said Dr. Richard Freeman, a transplant surgeon at Tufts University School of Medicine in Boston, who helped create the new system and was not involved in the study.

But the research, in today’s Journal of the American Medical Association, suggests the system may favor men over women. Dr. Cynthia Moylan, the study’s lead author and a transplant fellow at Duke University Medical Center in Durham, N.C., called for more research on gender differences.

The nation faces a serious shortage of livers from deceased donors, with nearly 16,000 people now waiting. About 6,500 liver transplants were performed last year, but 1,602 people died waiting for a new one.

Under the old system, which relied heavily on how long a patient spent on an official waiting list, sicker patients were passed over in favor of those waiting longer.

The system favored whites because blacks join waiting lists when they are sicker. Why isn’t clear, but blacks may get treatment later or have poor access to liver specialists.

Compared with whites, blacks on the waiting list had a 50 percent greater chance of dying or becoming too sick for transplant within three years, according to an analysis of five years of transplant records before the change. After the new system, called Model for End-Stage Liver Disease, or MELD, that difference disappeared.

The new system is based on three lab tests. Results are combined as a score that predicts a patient’s risk of death within three months. Livers are allocated based on scores.

The change was made after the government ordered the United Network for Organ Sharing, which runs the transplant network, to make liver allocation less arbitrary.

Prior research has also found racial disparities in the allocation of kidneys. UNOS is currently evaluating its system for kidneys, which is now based on waiting time, blood type and tissue type.