August 23, 2016

Vanderbilt community urged to comment on proposed UNOS changes that will reallocate livers for transplantation

Seth Karp

Seth Karp

To the Vanderbilt Community,

As you may be aware, thousands of people in the United States die each year due to a lack of availability of life-saving organs for transplant.  There is currently a proposal that has been forced forward by UNOS (United Network for Organ Sharing), which has the government contract to manage transplantation in the United States. 

This proposal has been supported by a lobbying group from New York and a number of well-connected transplant centers which stand to benefit from the new rules.  Unfortunately, the proposal results in a massive movement of organs from the South into New York, which has the worst donation rates in the country.  We believe this proposal has been developed by individuals driven by conflict of interest and results in an outcome that is absolutely unacceptable in which patients in Tennessee and the South will lose important access to these life-saving organs. 

By government regulations, the proposal is being offered for public comment.  We ask that you consider placing a public comment by visiting and clicking on ‘join the discussion’ and then add your comment. 

It is important that our voice is heard.

For reference, the following are the critical issues.  The proposal

1)    will result in fewer overall transplants.

2)    will cause smaller and rural centers to close and/or weaken, increasing disparity and access to


3)  will decrease the availability of transplants to citizens of Tennessee and most of the South.

4)  rewards centers that list patients from other countries who are not citizens or residents of the United States

5)  in many cases moves organs from areas of high waiting list mortality into areas of low lab MELD / low waiting list mortality exacerbating disparity and access to care

6)   does not hold local communities accountable for organ donation and rewards poorly

performing organizations responsible for donation

7)   dramatically increases costs for transplant programs and OPOs (Organ Procurement Organizations).

8)   increases travel and risk for physicians

9)   increases logistical complexity of organ distribution and will likely lead to organ loss.

9)   was developed in a setting of extreme conflict of interest and without attention to objections and

       meaningful input from the transplant community and thus does not have the support of the liver

       transplant community.

10)   destroys the bond between OPOs and local centers and communities

11)   directs a massive redistribution of resources across the country on a theoretical, ideological, and conflict-of-interest laden campaign, an example of unchecked bureaucracy.

12)  will lead to increased competition for organs

13)   will lead to worse overall outcomes as sicker patients receive transplants

14)   did not provide meaningful consideration of other models including concentric circles using different geographical distances and circles based on population density.

For these reasons we should speak out to protect the availability of life-saving organs for the people of Tennessee and surrounding states.


Seth Karp, M.D.

H. William Scott Jr. Chair

Professor of Surgery

Chair, Department of Surgery