UCSF Transplant Surgeon Ryutaro Hirose, M.D. Instrumental in New Liver Transplant Donation Guidelines

The Organ Procurement Transplantation Network (OPTN) recently updated the liver distribution policy to provide better efficiency and fairness for transplant patients – regardless where they live, what hospital they choose for care or how sick they must be before being likely to get a transplant – and a UC San Francisco transplant surgeon was instrumental in its development.

UCSF Health transplant surgeon Ryutaro Hirose, M.D. was former chair of the OPTN Liver and Intestinal Organ Transplantation Committee, which formulated the new policy that adjusts how geography is considered when matching donated livers with transplant recipients. Called the Acuity Circles model, liver transplant candidates are now prioritized in relation to the distance between the donor hospital and transplant hospitals so those both most in need and closest to the donor get offers first.

Under the previous policy, adopted by OPTN in 2013, donated organs were first offered to transplant candidates who lived in the same donation service area or region where the organ was acquired. There are 11 regions, or groups of states, and 58 donation service areas, smaller geographic areas irregularly drawn and not bound by state lines.

“This is the beginning of a new era in liver distribution in this country,” said Hirose, professor of transplant surgery at UCSF. “We are no longer using donor service area boundaries, and keeping organs geographically restricted, often in a provincial or parochial fashion, but rather distributing organs to those critically ill patients with liver disease most in need. This may not be a perfect solution, but it is a step in the right direction.”

The new policy was developed over more than five years by Hirose and other transplant experts, organ recipients and donor families nationwide, along with more than a thousand public comments. 

The OPTN Board of Directors approved the policy in December 2018, and it was implemented briefly in May 2019 before reverting to the prior system while a federal court considered a legal challenge to the new system. A court ruling issued Jan. 16, 2020, allowed the re-implementation to proceed.