Before answering questions about OHSU’s liver transplant policy, we would like to take this opportunity to stress the critical importance of organ donation. More than 114,000 people are waiting for lifesaving organs, and more than 3,000 of them live in the Pacific Northwest. According to Donate Life Northwest, cornea donation restores sight to thousands of people every year. A single tissue donor can touch more than 50 lives -- healing a burn victim, saving the life of a newborn with congenital heart defects, replacing tumorous bones and more. Registering as an organ donor save lives. To learn more about organ donation, visit Donate Life Northwest.
1) What is the reason behind your policy regarding health insurance for the liver transplant program?
Candidates for liver transplantation are rigorously screened to ensure they meet the criteria for selection. The criteria exist to ensure that the transplant team is allocating this scarce resource to patients who have the best expectation for long-term success with a transplanted organ, including the requirement that patients have health insurance and compliance with a strict medical regimen pre- and post-transplant. Ethically, transplant centers nationwide understand their deep responsibility to waiting patients as well as to the families who so generously agree to donate. This is a calling for our transplant team, so the difficult decision to deny an evaluation, under any circumstance, is heart-wrenching to all involved. Every day transplant teams nationwide face the potential for the death of patients on the waiting list. We understand well the gravity of the decision.
2) What does the selection process entail?
The selection process is a multidisciplinary one involving extensive clinical and psychosocial assessment. Patients must make an absolute commitment to long-term compliance with a strict medical regimen both pre- and post-transplantation in order to realize the best success in their outcome derived from a scarce and precious resource.
3) How many people die while on the waiting list?
Today there are 114,870 patients on the National Waiting list. On average 20 to 22 people die every day while waiting for an organ transplant. This includes patients who have become too sick for transplant and are no longer eligible. In 2017, 31,608 organs were recovered from deceased donors and were suitable for transplantation; another 6,000 organs from living donors were transplanted.
4) How often has the liver transplant policy been applied to patients with undocumented status?
OHSU’s liver transplantation policy does not explicitly list immigration status as a reason for denying an evaluation; however, because insurance is a requirement for all transplant services, over the past decade, some individuals with undocumented status were denied transplant evaluations due to lack of insurance or insufficient insurance. In addition, over the same time period, some patients who qualified for Medicare coverage were denied transplant evaluations because Medicare does not reimburse for services provided to individuals with undocumented status.
Unfortunately, prior to Feb. 8, 2018, the policy also was interpreted to include legal status as a reason to deny a liver transplant because of the uncertainty faced by individuals with undocumented status, and an assumption was made that they may not have the psychosocial support and financial resources for the post-transplant care requirements outlined in the policy. OHSU deeply regrets that this occurred, and OHSU leaders have directed our Legal team to conduct a system-wide audit to ensure no other such policies, practices or interpretations exist.
5) Has OHSU denied any other patient services based on immigration status?
We continue to seek information from departments to determine if similar policies or practices are in place. As President Dr. Joe Robertson has repeatedly stated: All are welcome at OHSU, and we will be working to ensure that everyone at OHSU is acting in accordance with this principle. OHSU is committed to providing compassionate, high-quality care to our entire community. Diversity, equity, inclusion and creating a safe space for all are central to our core values and missions.
6) Who’s going to pay for this transplant?
The patient’s family has authorized OHSU to confirm what her family has shared publicly: The patient has health insurance through her husband’s employer.
7) What is OHSU going to do to protect this patient from ICE, deportation?
In his commentary, All are welcome at OHSU, President Dr. Joe Robertson is explicit about OHSU’s stance on immigration enforcement: “While we are duty bound to follow the law, OHSU will not facilitate or cooperate with immigration enforcement activities. We will not share with the federal government confidential student, patient or employee information related to immigration status. The OHSU Department of Public Safety will not act on behalf of the federal government to enforce immigration laws.”
8) What is the actual policy that was used?
The OHSU liver transplantation policy, “Liver Transplantation Patient Selection Criteria,” describes the various medical and psychosocial criteria our transplant team evaluates in determining whether a patient should be placed on the transplant waiting list.
10) Why wasn’t leadership aware of the policy?
Leadership was not aware that this decade-old policy was being interpreted in a manner inconsistent with our values. At the direction of OHSU leadership, OHSU’s legal team has begun a system-wide audit to ensure no other such policies, practices or interpretations exist.
OHSU is a member of the United Network for Organ Sharing, a private, nonprofit organization that manages the nation’s organ transplant system under contract with the federal government. To learn more about how organs are allocated and to view a list of frequently asked questions about transplantation, click here.
In addition to frequent consultations with the transplant team, all liver transplant patients receive a number of educational resources, including the following UNOS publications:
- “Questions and Answers for Transplant Candidates about Liver Allocation Policy” (PDF)
- “What Every Patient Needs to Know” (PDF)