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Organ network adopts new patient-ranking system

WASHINGTON, Nov 16 (Reuters Health) - Patients awaiting a liver transplant will no longer receive donated livers on a first-come, first-served basis.

The nation's transplant network has voted unanimously in favor of changing that system in favor of one that ranks patients on the basis of need.

The new system will be based on formulas--one for children and another for adults--that use laboratory tests to calculate patients' short-term risk of dying without a transplant.

Under the current system, patients already are categorized into urgency groups. But the present system uses the amount of time patients spent on the waiting list as a tiebreaker.

The revised system would replace all but one of the four existing categories with a continuous score, giving those with the highest score first crack at a transplant no matter how long they have been on the waiting list. The top category meant for those in the most critical condition will remain as the only firm category in place.

The change comes at a time when the transplant network has faced growing criticism for failing to distribute organs to the neediest patients.

Much of that criticism has focused on the network's refusal to distribute donated livers across geographic borders. Critics have said this system allows patients in one city to die, while a healthier patient in another area receives a transplant.

The new system will not address those concerns. Scores will be compared within the preset geographic borders.

Still, representatives of the United Network for Organ Sharing (UNOS) said they believe the changes would create a fairer system.

UNOS is the non-profit organization that maintains the national Organ Procurement and Transplantation Network under a contract with the Department of Health and Human Services.

"We believe this new system is objective, it will save lives on the waiting list, and it allows for additional enhancements," said UNOS President Dr. Jeremiah G. Turcotte in a statement.

UNOS added that the new system would take effect in 2002, pending approval from HHS and a transition period aimed at allowing patients who have spent a long time on the waiting list to have a chance at receiving a donated organ.

The vote was taken on Thursday at the organization's mid-year meeting in Alexandria, Virginia.

UNOS also voted to ease its rules on infant heart transplants. Under the new policy, UNOS will now permit babies younger than 1 year old to receive heart transplants that don't match their blood type.

This change followed the widely reported case of a 6-week-old girl in Denver, Colorado, who died in September while awaiting a heart.

Calls to UNOS seeking further details and comment were not returned at press time.

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