The University of Iowa Hospitals and Clinics has entered into a lawsuit with thirteen other parties over new federal legislation that would change how liver transplants are allocated nationwide.

The new legislation has many changes, but the most contentious one changes how donor’s livers are distributed over geographic regions. Prior to this new law, donor’s livers were distributed by proximity. That is to say, compatible livers were first given to the closest available patient. The law changes this to a need-based system. So now instead of looking for the closest patient, they are now instructed to look for the patient in the most need within specific geographical ranges.

A representative from the United Network for Organ Sharing, one of the organizations who supported the drafting of this bill, states that this new law is more equitable and will save lives. The UNOS rep cited the fact that approximately 3 people die every day waiting for an organ transplant and that this new legislation is designed to prevent those deaths. By switching to a need-based system, UNOS claimed, 100 more lives per year will be saved. An official from the Iowa Donor Network has stated that under current legislation, they are unable to either give or receive livers across the Mississippi river, but this new policy will allow them to both aid and be aided by their neighboring state of Nebraska.

Opponents of the bill have claimed that despite the well-intentioned nature of the legislation, it will come at the cost of liver transplants for underserved and rural communities. The lawsuit claims that this negative effect will amount to these communities receiving 20% fewer liver transplants per year—a massive drop in a life-saving procedure. Experts have claimed that this will most harshly impact rural communities and states in the south.

Organ transplants are still a hot issue. In 2018 there were approximately 16,000 individuals on the waitlist for an organ. Of that 16,000, only 11,000 ever received one. The Director of the UIHC has claimed that no matter how this legislation comes down, more work is needed to fix the root of the problem.