By: Tom Wilemon
A long-standing share arrangement that has given transplant centers in Tennessee first priority for in-state liver donations has come to an end, despite a waiver request from a Memphis hospital.
The Centers for Medicare & Medicaid Services denied that request this month. It means that wait times for people in need of liver transplants will probably become longer unless more people agree to become donors.
New rules by the Centers for Medicare & Medicaid Services split the state into two organ procurement regions. That created a supply-and-demand issue for Methodist Le Bonheur Healthcare, which has the nation's fourth largest liver transplant center.
Instead of receiving first-priority organs from the state's two donor organizations, the Memphis hospital is now paired with the smaller one, Mid-South Transplant Foundation.
Methodist Le Bonheur sought a waiver to end its partnership with the Memphis-based organ procurement organization (OPO) and affiliate instead with the larger Nashville-based Tennessee Donor Services. It also pushed for Mid-South Transplant Foundation to merge with Tennessee Donor Services.
If granted, the affiliation between the Memphis hospital and the Nashville OPO also would have applied to kidneys and other organs.
But CMS said no, determining that a waiver would perpetuate a system that gives people in Tennessee an unfair advantage over people in other parts of the nation waiting for organs.
"After carefully considering all the comments received, we find that the approval of the waiver would not increase organ donation and would maintain an organ-sharing arrangement that does not ensure the equitable treatment of patients," Jonathan Blum, a deputy director for CMS, said in a Dec. 20 letter.
Vanderbilt University Medical Center had objected to the waiver.
Although the new rules are expected to increase wait times, the waiver had the potential to make the situation worse for transplant candidates in Middle Tennessee. People on Vanderbilt's waiting list would have ended up competing against Memphis-area residents for organs procured by Tennessee Donor Services. Mid-South Transplant Foundation also objected to the waiver request.
Methodist Le Bonheur waged a public campaign in hopes of persuading federal officials to grant the waiver. Mid-South Transplant Foundation responded by hiring a public relations firm to make its case - the foundation would have been procuring organs for patients outside the state because it had no affiliated hospital here.
Vanderbilt made no public comments but said in a letter to CMS that Methodist Le Bonheur had created its own problems by performing too many transplants on people from outside the region it served. Besides a 2009 liver transplant for Steve Jobs, Methodist also has served patients from Puerto Rico, where no hospital had performed a liver transplant until March of this year.
"The current system of organ allocation and distribution serves the needs of Tennesseans and the rest of the country extremely well, ensuring that life-saving organs are equitably distributed to patients throughout the Southeast and across the country," said John Howser, a spokesman for Vanderbilt. "We appreciate that the Center for Medicare and Medicaid Services saw fit not to grant an exception to this system."
Kim Van Frank, executive director of Mid-South Transplant Foundation, expressed appreciation for people who sent letters opposing the waiver request.
"Our recent successes and accomplishments, including ranking number one in the continental U.S. for African-American donation rates, are a testament to the hard work of our staff and the relationships we have built with our donor and transplant hospitals," Van Frank said. "We are ready to move past this issue and look forward to continuing our longstanding relationship with Methodist Transplant Institute."
The transplant program is a partnership between Methodist Le Bonheur in Memphis and the University of Tennessee Health Science Center.
Kevin M. Spiegel, the CEO of Methodist University Hospital, the Methodist Le Bonheur facility where liver transplants are done, said his organization would continue advocating for ways to unify organ access in Tennessee.
"Most states have only one OPO," Spiegel said. "Tennessee has two. It divides the state by 20 percent and 80 percent (geographically). We don't believe that's in the patients' best interest, and we're going to continue to advocate for patients of Tennessee."