Rationing transplant organs by 'benefit' -- to whom?

November 21, 1996|By Carl T. Rowan

WASHINGTON -- Scientific advances in medicine have made it possible for man to play God, and there is painful evidence that man isn't very good at it.

Witness the heart-tugging disagreements within the United Network for Organ Sharing, the private group that decides who gets priority for receiving, say, a liver transplant.

This group has long held to the policy that the inadequate number of livers available for transplants should be rationed out, with priority going to the sickest people closest to death. But the group decided Thursday at its annual meeting in Boston to make a profound policy change: Priority will now go to a small number of ''acute'' patients deemed ''most likely to benefit'' from a liver transplant.

The doctors' task

While we don't know all the delicate implications of this policy change, it is clear that a lot of doctors will have to tell woefully ill patients that they won't get desperately needed new livers.

''My prediction is you're going to see a massive increase of patients that are going to die,'' said Dr. John J. Fung, chief of transplant surgery at the University of Pittsburgh Medical Center, where a large percentage of liver transplants are performed.

Among those doomed by this policy change are patients with chronic liver problems -- that is, genetic liver disease or livers damaged by heavy consumption of alcohol or viral hepatitis, which may be caused by injecting drugs with dirty needles. No matter how close to death, people in this group will no longer have the same priority as someone who suddenly develops a liver crisis by eating poisonous mushrooms or develops an acute illness that threatens imminent death.

No moral judgments

Members of the United Network for Organ Sharing insist that they are not making moral judgments against alcohol drinkers or drug users. But the clear implication is that boozers and druggies are less likely to benefit from a new liver than are people who live ''cleaner'' lives. Many hospitals and surgeons already had imposed rules that they would not give liver transplants to anyone who had not been sober for six months or more.

Some medical people see ''disaster'' in taking priority for a new liver away from ''the sickest'' to ''those most likely to benefit'' when the supply of livers is barely half the number of people waiting for one. They say the new policy opens the door to more God-playing where subtle discriminations will be harder to detect.

When the United Network decides which ill person is most likely to benefit from receiving a scarce organ, can it avoid judgments about which allocation would do the most for society?

A mere English teacher

Might it not be better to grant a new liver to a young scholar with an alcohol problem who is doing promising research on cancer than to give that organ to an abstemious young man who ''only teaches English?'' Or would that be a reprehensible judgment?

Can the United Network avoid giving preferences to celebrities or members of preferred groups in determining who will benefit most from a new liver?

These organ transplants are, after all, ultimate judgments as to who shall live and who shall die.

We must insist that the Department of Health and Human Services monitor this new policy closely, to see that it is implemented with bone-clean fairness.

In the meantime, we all need to join in a campaign to ensure that more donors give more kidneys, livers and the other organs that are so much in demand so that this United Network for Organ Sharing can do less God-playing.

Carl T. Rowan is a syndicated columnist.

Pub Date: 11/21/96

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