Mulligan says he supports the recommendations from the Johns Hopkins study and that the OPTN/UNOS liver committee is reviewing redistribution models. Now, however, he says the biggest roadblock towards a coordinated national system may be turf wars among transplants centers.
"I would love to say that everyone is on the page. We all agree that all of the transplant physicians and surgeons and organ procurement organizations want what is best for their patients. The biggest roadblock is getting buy-in for thinking in a different parameter, taking a step back and saying what is best for all patients in the United States," Mulligan says.
"The big piece is to get everyone to look at the big picture, to look at all patients in the country and not just their own. Because in areas where there is a huge disparity and long waiting times in liver transplants those centers are going to be excited to see a new opportunity for their patients to get organs more effectively and efficiently."
"On the flip side," Mulligan says, "centers and regions in the country that have very productive organ procurement organizations and a lot of organ donation and populations of donors who are very motivated, those centers look at this type of a proposal as a hurt to their patients, that their patients are now going to have to wait longer because they are sharing with other centers."