The United Network for Organ Sharing issued procedural changes in late June for matching and distributing organs-changes they hope will reduce the potential for mismatching organs and patients. However, some doctors are worried that UNOS's new guidelines are actually prohibiting some organ transplants and allowing deaths that could otherwise be prevented.
The changes are the result of a formal investigation into transplant safety following the death of Jesica Santillan in February, when surgeons at Duke University Hospital transplanted a heart and lung of the wrong blood type. The matching process now includes at least six separate checks of blood type compatibility between donor and candidate and demands strict adherence to "match-run" procedure, which establishes an order of eligibility for potential transplant patients.
It is the rigidity of the match-run rules that concerns some doctors.
"UNOS had insisted that [doctors] follow the match-run list by the letter of the law," said Dr. Duane Davis, director of transplantation at the Hospital. He explained that some critically-ill candidates for transplantation are often too low on the waiting list to be put on the match-run, but that organs which could help those people often go unused. Those organs can be connected with patients through informal channels, something prohibited under current guidelines.
"Right now if you follow what UNOS is insisting, the only thing that could happen to you is to die," Davis said. He added that six Hospital patients died waiting for organs in the month after the UNOS rules took effect, but none had died on the waiting list in the previous two years.
Officials at UNOS said the rules will help more people match with organs in the long run. "Before, [the rules] didn't tell you what to do if you exhausted the match-run," said Anne Pashke, a spokesperson for UNOS. "Now there are guidelines."
About 1.6 percent of organ matches are not done through match-runs, UNOS officials said.
UNOS is looking at ways to better regulate match-run procedure to avoid wasting organs, but the process has already been underway for several years and does not yet have a solution.
In contrast to match-run changes, UNOS's additional verification steps for matching organs have been well received by the medical community as a way to increase patient safety and diminish human error.
The Hospital is not heavily affected by the increased checking because it already increased the stringency of its transplantation procedures immediately after Santillan's transplant error. "Many of the UNOS changes mirror those that we made immediately following the mismatch a few months ago," Dr. William Fulkerson, CEO of Duke Hospital, said in a statement.
Additional checks will likely have a positive effect on patient safety, Davis said. He added that the stress of increased verification will primarily affect hospital staff rather than doctors, who have always been accountable for checking blood compatibility.
"I think that there's a little bit of morale cost. Most of this stuff is done in the middle of the night. What that means is that people are awake and doing more work at times when they would rather be doing other activities, like sleeping," Davis said. "But they do increase safety."
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