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REDISTRICTING MIGHT SHORTEN WAIT FOR A NEW LIVER

Tuesday, 20 August 2013 11:23 Published in Health & Fitness
WASHINGTON (AP) -- Where you live can affect your chances of getting a liver transplant, and your risk of dying while waiting. The nation's transplant network says it's time to make the system fairer - and it may take a cue from how politicians redraw voting maps.

"Gerrymandering for the public good" is how Johns Hopkins University transplant surgeon Dr. Dorry Segev describes a proposal to change the map that governs how donated livers are distributed around the country.

The problem: Some areas have fewer donated organs, and higher demand for them, than others. The sickest patients go to the top of the waiting list. But the geographic variation means that someone in California, among the toughest places to get a new liver, waits longer and is a lot sicker before getting transplanted than someone in Ohio or Florida - if they survive long enough.

"This should not be happening," Segev said.

Segev is advising the United Network for Organ Sharing, which runs the transplant network, as its liver specialists consider the novel idea of "redistricting" how livers are allocated - redrawing the nation's 11 transplant regions based on the distribution and demand for donated organs, much like lawmakers set political districts based on the party voting histories of different areas.

The ultimate goal: "That your chance of dying without a liver transplant doesn't depend on your ZIP code," said Dr. John Roberts, transplant chief at the University of California, San Francisco.

The geographic disparity adds another hurdle to the already dire shortage of livers. Just 6,256 patients received a liver transplant last year, all but a few hundred from deceased donors. Nearly 16,000 people are awaiting a liver. About 1,500 people die waiting every year.

Desperate patients sometimes travel across the country to get on a shorter waiting list, if they can afford it or even know it's possible. The best-known example is the late Apple CEO Steve Jobs, who lived in California but in 2009 had a transplant in Memphis, Tenn., which at the time had one of the shortest waits. That's harder for the less wealthy to do.

"I could have withered away here," said William Sherbert, 47, who temporarily moved from California to Florida for a faster transplant.

When hepatitis B caused liver failure, Sherbert spent a year awaiting a transplant from a Los Angeles hospital. He was getting steadily sicker, but was nowhere near the top of the transplant list when his frantic partner finally unraveled how the system works.

Patients who have the highest MELD score - a ranking, based on laboratory tests, that predicts their risk of death - move up the waiting list. But it's not a single national list. The 11 transplant regions are subdivided into local areas that form individual waiting lists, and there are wide variations in organ availability within regions as well as between them. Generally livers first are offered to the sickest patients locally and then regionally. Changes that began this summer will allow some of the sickest patients access to livers from other parts of the country, an initial step to address disparities.

United Network for Organ Sharing figures show that in three regions stretching from Michigan and Ohio down to Florida, adults receiving new livers over the past two years had median MELD scores of 22 to 23. But in the region that includes California, recipients were far sicker, with a median score of 33. Nearly as tough were regions that include New York, and the Dakotas and Illinois.

An Internet database, the Scientific Registry of Transplant Recipients, compares transplant center wait times and success rates so people can choose where to go. They can get on more than one waiting list if they meet each hospital's qualifications, and if they can get to that center within a few hours of being notified that an organ is available. Often, that means moving.

"It's really a shame" that people have to consider such a step, Sherbert said. But he's glad he switched to a Florida hospital's list, possible only because his health insurance paid for the transplant plus the couple's airfare and some living expenses during the seven-month wait. Sherbert is feeling well after his May 2012 transplant, and is back home in Garden Grove, Calif.

In a study published last month in the American Journal of Transplantation, Segev's team used computer modeling to redistrict the transplant regions, better balancing local areas' supply and demand. Segev said 28 percent of Americans live in an area where they'd have a high risk of death before getting a new liver, and redistricting could drop that proportion to as little as 6 percent.

The transplant network's liver committee is considering different map options as it debates how to improve fairness without having to fly organs too far around the country. One big challenge will be turf wars, as transplant centers with shorter waits understandably don't want them to lengthen, said committee chairman Dr. David Mulligan of the Mayo Clinic in Phoenix.

"Every doctor wants the best for their patients. The issue becomes stepping back and looking at the big picture and thinking about all the patients," said Mulligan, who hopes to have a proposal ready for public comment within two years. "Yes, your patient waits a little longer, but they can wait a little longer."

Smaller disparities exist for some other transplants, including kidneys, but the transplant network is focusing first on livers. It wouldn't be a problem if there were more organ donors, Mulligan noted, encouraging people to register: "It's the last chance we have to be a hero in our lives."

© 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.

NEW LYME DISEASE ESTIMATE: 300,000 CASES A YEAR

Tuesday, 20 August 2013 11:22 Published in Health & Fitness
ATLANTA (AP) -- Lyme disease is about 10 times more common than previously reported, health officials said Monday.

As many as 300,000 Americans are actually diagnosed with Lyme disease each year, the Centers for Disease Control and Prevention announced.

Usually, only 20,000 to 30,000 illnesses are reported each year. For many years, CDC officials have known that many doctors don't report every case and that the true count was probably much higher.

The new figure is the CDC's most comprehensive attempt at a better estimate. The number comes from a survey of seven national laboratories, a national patient survey and a review of insurance information.

"It's giving us a fuller picture and it's not a pleasing one," said Dr. Paul Mead, who oversees the agency's tracking of Lyme disease.

The ailment is named after Lyme, Conn., where the illness was first identified in 1975. It's a bacteria transmitted through the bites of infected deer ticks, which can be about the size of a poppy seed.

Symptoms include a fever, headache and fatigue and sometimes a telltale rash that looks like a bull's-eye centered on the tick bite. Most people recover with antibiotics. If left untreated, the infection can cause arthritis and more severe problems.

In the U.S., the majority of Lyme disease reports have come from 13 states: Connecticut, Delaware, Maine, Maryland, Massachusetts, Minnesota, New Hampshire, New Jersey, New York, Pennsylvania, Vermont, Virginia and Wisconsin.

The new study did not find anything to suggest the disease is more geographically widespread, Mead said.

---

Online:

CDC report: HTTP://WWW.CDC.GOV/LYME/

© 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
SANTA FE, N.M. (AP) -- A national outbreak of salmonella has been linked to an eastern New Mexico hatchery that sells live baby chickens, ducks and other poultry by mail and supplies them to feed stores, state health officials announced Monday.

The state Department of Health said a strain of salmonella that's infected more than 300 people in 37 states was found in a duck pen at Privett Hatchery in Portales.

No deaths have been reported, but 51 people have been hospitalized, according to the Centers for Disease Control and Prevention. Children ages 10 and younger account for nearly three-fifths of those who've become ill.

People buy baby chickens and other poultry to keep as pets and to raise the birds for eggs or meat.

Paul Ettestad, state public health veterinarian, said the hatchery was most likely the source of the outbreak. However, he said questions remain because federal officials have found that the people sickened with salmonella had purchased baby poultry at 113 feed store locations that were supplied by 18 mail order hatcheries in several states.

The CDC said more testing is ongoing.

Privett Hatchery said in a statement on its web site that it's cooperating with state and federal officials, and that some of the salmonella cases may be linked to its operation.

The department said the hatchery has agreed not to sell any poultry from the pen where the salmonella strain was found, will administer a vaccine to its birds and include a brochure on the safe handling of baby poultry in all of its shipments.

According to the CDC, the salmonella cases have occurred across the country - from California to New York - since March. Colorado has reported the most cases, 37, followed by Texas with 32.

Salmonella infections can happen when baby chicks are brought inside a home and children handle them. People should thoroughly wash their hands after touching live poultry or anything in the area where they roam, the department said.

---

Online: Centers for Disease Control and Prevention's salmonella webpage: HTTP://1.USA.GOV/17ZSGBB

© 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.

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