New rules aim to change how donated livers are distributed so that fewer people die waiting for a transplant, but they come amid a fierce fight over fairness.

Where you live makes a difference in how sick you must be to get a transplant. Beginning Tuesday, the transplant system ordered wider sharing of donated livers, so that people don’t get priority over someone sicker because they live closer to the donor hospital.

Places with severe shortages like New York pushed for the change. Some hospitals in parts of the Midwest and South sued to block it, arguing rural patients will wait longer as livers are shipped to cities with fewer donations. A federal judge refused to delay the rules but those hospitals are appealing even as they took effect.

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