The United Network for Organ Sharing is returning to its old distribution map governing donated livers after a federal court in Atlanta threatened to hold the agency in contempt.
"Reprogramming this complex and important system is not a simple process and will take time to execute," UNOS spokeswoman Anne Paschke says in a written statement released Friday afternoon. "However, it is underway now and UNOS will have a greater sense of when the work will be completed next week."
Just hours after the U.S. District Court denied a temporary restraining order sought by Vanderbilt University Medical Center and a dozen other transplant centers, the agency moved forward Tuesday morning with a new method for deciding who receives donated livers.
Instead of 11 priority regions, the new plan generally gives the available liver to the most severe patient within 500 nautical miles — meaning a liver donated in Lexington, Ky., could end up at Johns Hopkins in Baltimore, Md.
The plan is meant to resolve regional inequities that developed in recent decades. Wait lists in New York, Los Angeles and San Francisco have grown much longer than in most of the Midwest and South, where organ donation rates are higher and more people die from strokes, which makes them good donor candidates.
But U.S. District Judge Amy Totenberg told UNOS to "cease and desist implementation" of its new policy once the transplant centers who've filed a lawsuit appealed the denial late Monday night of their request for a temporary restraining order. (It's confusing, we know.)
UNOS didn't take immediate action, saying the policy was already fully implemented Tuesday morning. "There are no further actions or 'efforts' that are necessary to 'continue,'" UNOS attorneys wrote.
But on Friday, Judge Totenberg threatened contempt, prompting UNOS to act. The agency has said it could take several weeks to get back to the old regional policy, though in the meantime livers will continue to be matched with recipients.
Parties in the lawsuit are scheduled to update the court on Tuesday.
"It's very upsetting. That's what I can say," says Vanderbilt transplant director Seth Karp. "I'm happy for the patients in Tennessee, and I'm happy because we're going back to the old system, which I think is better than what they wanted to change it to, but there's no joy here that this is such a mess."