University Hospital will soon begin transplanting livers, becoming the second Utah transplant center to do the complex procedure.
Whether that's good news for the growing number of patients who will need a liver transplant — or bad news that reduces the opportunity surgeons have to hone their skills on the procedure — depends on whom you ask. There are strong feelings on both sides.
Rancor has likely torpedoed discussions between the U. and LDS Hospital, which this year celebrates its 20th anniversary doing liver transplants, on perhaps forming a liver transplantation collaboration that would standardize patient care and transplant technique and also share data for research. The initial talks envisioned collaboration at LDS and University hospitals and also at Primary Children's Medical Center. Intermountain Healthcare, which owns LDS Hospital and Primary, and University Healthcare, which includes University Hospital, have similar partnerships in other areas, including cancer care.
What's more likely now, insiders for both programs agree, is heightened competitiveness.
The effort to form a collaboration "went well until we had to define leadership of the combined program," said Dr. Sean Mulvihill, chairman of the Department of Surgery at the University of Utah, who heads University Hospital efforts to get the liver transplant program up and running.
Dr. John Sorensen, who was director of the LDS Hospital liver transplant program, now works at the U.
Mulvihill said it's very unusual for an academic center such as the U. to offer some transplants, but not liver. That's something the U. planned to change even before it hired him five years ago, he said.
It's hard for a program that doesn't include a liver transplantation component to recruit the best transplant surgeons and researchers, said U. Hospital spokesman Christopher Nelson.
On the other hand, counters LDS Hospital spokesman Jess Gomez, "One of the questions we have is why you would duplicate a service that exists that is not only one of the top programs in the region, but one of the top in the country — a program with a 20-year record of excellence for transplantations — when you have such a small patient population in this area."
LDS Hospital transplants about 40 livers a year, a number limited only by availability of donor livers, Gomez said. "Until the number of donors significantly increases, the number of transplants will likely remain in that range."
On Wednesday, there were 66 people on Utah's waiting list for a liver transplant, according to Ben Dieterle of Intermountain Donor Services, which coordinates organ and tissue transplants in Utah. The agency works with transplant programs at both hospitals.
Dieterle said need for liver transplants is growing, in part because people are living longer and older patients are more likely to need a transplant, and also because of unhealthy lifestyle choices that may damage organs.
Hepatitis C, which the Centers for Disease Control and Prevention calls the leading reason for a liver transplant, is also likely to inflate waiting lists. The number who have the virus — many without knowing it — has been growing for 20 or so years. And that's about how long it takes for any liver damage to begin showing.
"Need for liver transplant has been outpacing donors for the last decade," said Dieterle. Still, the time Utahns spend on waiting lists is already considerably shorter than the national average and most get a new liver within a year. Utah has one of the shortest wait times in the nation.
Dieterle said the number of donor livers is also likely to inch up. A new organ recovery technique referred to as DCD (donation after cardiac death) lets doctors harvest livers that would not have been used before because a donor was not on a ventilator to make the organ viable. DCD provides quicker recovery of kidneys and liver that "hopefully will provide additional organs."
Sections of liver can also be transplanted from a living donor in limited circumstances, he said, but it's not often used. Parent to child is the best scenario for that.
How much Utahns will actually benefit or lose from having two transplant programs appears to depend on what happens to the number of people on waiting lists and the availability of donor livers.
Both camps have persuasive arguments.
Mulvihill said that universities emphasize research and strengthening that component will benefit people with dire liver problems. Research is absolutely essential if you want prevention and goes along with a good transplantation program.
Dr. LeGrand Belnap, head of the LDS Hospital transplant team, believes the new program will merely dilute the experience level of the surgeons. "There is no room for two liver transplant programs in the state," he said, adding that areas like Denver, which serve larger populations, only have one.
Adds Gomez, "It's vital that surgeons, nurses and other members of our transplant teams perform enough procedures to maintain the specialized skills and experience that are needed to operate a high-quality program. If you have two centers competing for 40-45 patients a year, will either get the needed volume of patients to ensure excellent outcomes?"
There are differing views on the impact on insurance, too. Advocates of the new program said it will give patients more options for care, while critics claim it could decrease ability to get local care.
Some insurance companies demand a hospital perform a certain number of procedures before they will cover a transplant there, Gomez said. "The unfortunate downside might be that patients will have to be sent to an out-of-state center that has the volume required."
Mulvihill said he still believes the team approach would be best for the community and he hopes the facilities will reach an agreement to collaborate. But he admits it has become less likely.