Nation’s liver distribution policy must be reversed, say Moran, Blunt, colleagues

The national liver distribution policy is disproportionately harmful to patients living in the Midwest and South and it must be reversed by the Biden administration, said U.S. Sens. Jerry Moran (R-KS), Roy Blunt (R-MO), and 14 of their colleagues.

In a Jan. 24 letter sent to U.S. Health and Human Services (HHS) Secretary Xavier Becerra, the senators urged him to reverse the administration’s “biased, partial and unjust allocation policy,” and gave Becerra 30 days to provide a plan outline to address the matter.

In their letter, the senators referenced emails released between the United Network for Organ Sharing (UNOS) and organ procurement organizations regarding the national liver allocation policy that they say show a pattern of collusion between UNOS and others prior to changes in the liver allocation policy. 

The emails were released in response to a Nov. 17, 2021, U.S. Court of Appeals for the Eleventh Circuit ruling against UNOS — the HHS contractor for organ procurement and transplantation — that found UNOS “repeatedly failed to live up to its production obligations” to release documents in ongoing litigation. The court also acknowledged that the documents showed “personal opinions about the relative merits of living in different regions of the United States.”  

“Mr. Secretary, these emails show, without a shadow of a doubt, that the liver allocation decision was fundamentally flawed, and the body charged with carrying it out is systematically broken,” wrote Sen. Moran, Sen. Blunt, and their colleagues. “In particular, the adoption of the allocation policy for livers has been fraught with inconsistency, a lack of transparency, and clear violations by UNOS in determining the policy.”

They also pointed out that in every instance such concerns have been brought to HHS, they have been disregarded.

For instance, the senators wrote that congressional action regarding their concerns has ranged from letters to the HHS secretary and the head of the Health Resources and Services Administration (HRSA), to questions at committee hearings, language included in several appropriations bills, requests to the Government Accountability Office and National Academy of Sciences to evaluate the process, and letters to UNOS.

“In addition to the concerns raised by members of Congress, more than a dozen transplant hospitals have taken the department to federal court to overturn the allocation changes for three different organs — lungs, livers and kidneys,” they wrote. “These actions clearly show that there is not unanimous, or even a majority, agreement on the radical changes underway on organ allocation policy.”

And because HHS has ceded authority to ensure a fair and equitable organ distribution process to a private contractor having virtually no oversight from HHS or HRSA, questions of accountability and responsibility exist, according to their letter.

Among the lawmakers who also signed the letter were U.S. Sens. Marsha Blackburn (R-TN), Roger Wicker (R-MS), and Todd Young (R-IN).