Our Organ Donation System Is Unfair. The Solution Might Be Too.

At any given time, there are about 13,000 people waiting for a liver transplant in the United States. Whether the cause is a virus, alcoholism or a bit of genetic bad luck, they’re all suffering while sick and scarred livers struggle to clean their blood. Over time, their intestines bleed. Fluid builds up in their legs and their chests. Their skin turns sallow. Confusion sets in. The only cure is to swap the old liver for a healthy one. Each year, about 8,000 people will get that chance. The rest will wait, getting sicker.

There are always more people who need a new organ than there are organs available. That’s true all over the country, but not every place has the same number of available organs. Some regions have more registered donors, which means how long you have to wait for a liver is partly determined by where you happen to live.

At the end of the month, that’s set to change. The organization that manages the national organ transplant system is trying to make the wait time for donated livers more equal nationwide. It might be a preview of what’s to come for all organ-donation systems, and it’s proving to be controversial. It’s created factions among transplant surgeons. Senators have gotten involved. At least one state has proposed legislation to keep organs donated by its citizens within state borders. It’s a fight over the definition of fairness, experts say, where a seemingly simple effort to reduce geographic inequity in organ donation could end up exacerbating even bigger inequities in health care access.