Organ
allocation regulation
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| Organ
allocation regulation
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| Illustration
by Malcolm Garris and William Jacoby Photo by Margie Paschke |
By Stephen
Flaherty Right now more than 55,000 people are waiting for an organ transplant, and every day 10 people die before they get one. For many, the debate over how organs should be distributed is about more than fairness—it’s about life and death. In April, the Department of Health and Human Services (HHS) released new guidelines that will drastically change the way organs are allocated for transplantation. While some members of the transplant community applaud the new rules as a long-overdue reform, others see them as federal interference with an organ-sharing network that works. The new guidelines will require the United Network for Organ Sharing (UNOS), the organization that runs the current organ distribution system under government contract, to develop revised organ allocation policies. According to HHS, the new policies will reduce disparities in the amount of time patients in different areas wait for an organ, ensure that patients with the most urgent needs get the organs first regardless of where they live, and institute a medically objective ranking system for selecting patients to receive transplants. UNOS has until Oct. 1 to develop a new system for allocating livers and a year to develop a system for other organs. Patients on the waiting list when the new rules take effect will not be affected by changes in the allocation process. However, UNOS does not believe that the new regulations will benefit transplant patients. "The government’s proposed transplant regulations could result in potentially tragic human consequences," it said in a recent statement. UNOS believes that the new guidelines could lead to longer waits, decreased success rates, and reduced access to transplantation. Goran Klintmaln, MD, medical director for Baylor University Medical Center transplant department, supports the regulations in principle. "The guidelines state what we all agree on, that there should be an equal chance for patients who are equally sick," Klintmaln said. However, the regulations’ emphasis on allocating organs to the sickest patients concerns him. "Some patients are too sick to receive an organ," Klintmaln said. "Patients who won’t survive a transplant shouldn’t get a scarce organ." Klintmaln also harbors reservations about the government’s role in developing the regulations. The new regulations allow the transplant community to create the new policy, but "once the political arm is involved, it can be difficult to limit its influence," Klintmaln said. Waiting for an organ Currently, patients awaiting a transplant are ranked depending on the severity of their illness and the criteria of the transplant center. When an organ becomes available, it is first offered to people in the local area, starting with the sickest. If there are no local patients, the organ is offered regionally, then nationally. Waiting times, as well as donating patterns, vary greatly, with patients in some areas of the country waiting five times longer for an organ than patients in other areas, according to HHS. The largest disparities in waiting times involve livers, and concerns involving liver allocation fuel the debate. It is the second-most frequently transplanted organ after the kidney, and it can last outside the body 12 to 24 hours, long enough to be shipped across the country. But according to UNOS, "As the number of hours a liver goes without a blood supply is increased, the likelihood of a successful transplantation significantly decreases." The disparity in waiting times is not as great as HHS implies, according to UNOS. The organization asserts that those in greatest need get the same treatment, regardless of where they live. For the sickest patients—those who are on life support and who have life expectancies of a week or less—the waiting period for a liver ranges from four to six days nationwide. Access for everyone Opponents of the guidelines say the new system will save fewer lives because small transplant centers will be forced to close as organs are diverted to large centers. According to UNOS, the closing of small centers could make it harder for many sick people, especially the poor, to reach a transplant center, and could lead to a drop in organ donation. Liver donations rise in communities that have transplant centers and decrease in communities where a local transplant center closes, according to UNOS. But Allison Smith, director of operations for Southwest Transplant Alliance, an organ procurement organization serving West Texas, is taking a "wait and see" attitude about the effect of the regulations on organ donation patterns. "People donate because it’s a caring, human thing to do," Smith said. Currently, there are definite inequities in waiting times, and anything the government does to change public perception of equity in the allocation policy may increase organ donations, she said. Encouraging donations In 1996, 20,000 Americans received an organ transplant. But there are more people waiting for a transplant than there are available organs. An estimated 12,000 people meet the criteria to become donors each year, but only one-third of them become organ and tissue donors. To many in the transplant community, organ shortage is the important issue, and increased donation is the real need. "The bottom line is that there are not enough organs to go around," Smith said. "If there are 10 people waiting and seven organs, three people will die." |
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}}|{{ For more information International Society of Nephrology/Renal Pathology Society The International Transplant Coordinators Society International Transplant Nurses Society The Texas Transplantation Society }}|{{ |
