By Genevra Pittman
Reuters

More competition between medical centers that perform liver transplants may mean sicker patients get lower-quality donor organs, a new analysis suggests. 

When more than one center has patients on the same donor list, the centers have an incentive to get organs for as many of their own patients as possible, researchers explained.

So doctors are more likely to take the first available organ when their patient is at the top of the transplant list - whether or not that pairing has the best chance to succeed - rather than risk the organ will go to another center.

"There is the question whether competition decreases the ability of a center to better match donor and recipient characteristics," Dr. John Paul Roberts from the University of California, San Francisco and his colleagues wrote.

They analyzed data on more than 38,000 liver recipients who had transplants from non-living donors between 2003 and 2009.

The transplants were done at 112 medical centers in 47 so-called distribution areas - some that were covered by only one center and some that fed organs to multiple transplant centers.

Roberts and his colleagues found "clinically important differences" showing patients who received organs were initially worse off, with a higher risk of dying or having their transplant fail, in areas that had more medical centers in competition for the same organs.

For example, 10 percent of patients who received organs at centers with no competition had the worst scores for liver disease severity pre-transplant, compared to more than 28 percent of those in the high-competition distribution areas.

Areas with high competition also transplanted more organs that were considered at higher risk of failing, according to the new findings published in the journal Liver Transplantation.

Although that might not be the best way of distributing organs on a society-wide scale, it could be considered a plus for the people who otherwise wouldn't get an organ or for livers that would otherwise be considered too low quality and be discarded.

"If you're a sick, high-risk patient… then it's in your interest that somebody will take more of a risk on you. The alternative is not surviving," said Dr. Michael Charlton, a liver disease researcher from the Mayo Clinic Transplant Center in Rochester, Minnesota.

Competition, he said, does increase access for patients. So people who are very sick and are turned away by a center that's the only place for transplants in its distribution area might have better luck elsewhere - if they can afford to travel, that is.

"The practice, in terms of choosing patients who can undergo liver transplantation and accepting organs that are already listed for transplantations, varies significantly between centers," Charlton, who wasn't involved in the new study, told Reuters Health.

Still, he cautioned that the way the researchers measured competition - comparing the market shares for each transplant center in a given area - doesn't account for the effect of a center's reputation for good outcomes, for example.

In that situation, a popular, higher-volume center would experience less competition from other centers and might also have better transplant records - so pure competition might not be the only explanation for outcomes.

Charlton pointed to the Scientific Registry of Transplant Recipients as a place where patients can go to see how many people various centers have on their organ waitlist in addition to how well their patients do after getting a transplant. (For liver transplants, that information can be found here:).

Surgeons who helped make liver transplants an almost everyday life-saving event, a team that shed light on the the inner workings of cells, and genetics experts who have acted as leaders in biomedical science have won prestigious Lasker awards, the Albert and Mary Lasker Foundation announced Monday.

The Lasker award for clinical medical research was shared by Dr. Thomas Starzl of the University of Pittsburgh and Dr. Roy Calne, an emeritus professor at Cambridge University, for developing liver transplantation.

Their work on the surgical procedure and treatment to prevent organ rejection was done initially in dogs. In 1960, Calne's dog experiments demonstrated for the first time that a drug could fend off organ rejection. Starzl attempted the first human liver transplant in 1963. That patient died during the procedure. The next several patients died within weeks of surgery, but they showed that transplanted livers could function.

Both men pursued further research, especially in blocking rejection. Liver transplantation finally gained acceptance in the 1980s, and it has "restored normal life to thousands of patients," the foundation said.

The award for basic medical research was shared by Michael Sheetz of Columbia University, James Spudich of Stanford University, and Ronald Vale of the University of California, San Francisco. They were honored for discoveries about the biological machines that make muscles contract and transport cargos within cells. Their work laid the foundation for research into treatments for conditions including cancer and a heart disorder that can kill young athletes, the foundation said.

The award for special achievement in medical science was shared by Donald Brown of the Carnegie Institution for Science in Baltimore and Tom Maniatis of Columbia University for "exceptional leadership and citizenship in biomedical science." Besides making key discoveries in genetics, both men have worked to help research by others. Maniatis co-wrote a manual on lab techniques, first published in 1982, that became widely used. Brown founded an organization that awards fellowships to young investigators and built an impressive biology research program at the Carnegie institution, the foundation said.

The prizes, worth $250,000 for each of three categories, will be presented in New York on Sept. 21.

The Lasker foundation was established in 1942. Albert Lasker was an advertising executive who died in 1952. His wife, Mary, was a longtime champion of medical research before her death in 1994. The prizes often go to scientists who later go on to win Nobel prizes.

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