Transplant information can mean life or death Decision: A Virginia-based organization aims to help patients awaiting organ transplants choose the procedures that best meet their needs.

November 09, 1997|By WALTER K. GRAHAM

It's likely that at least 4,000 patients will die in U.S. hospitals next year as they await organ transplants. This fact makes the need for reliable, accurate information an imperative for patients when they choose a transplant center.

This week in Baltimore, the national board of the nation's organ transplant network, the United Network for Organ Sharing (UNOS) will discuss how information about organ-acceptance rates can best help patients. This information is important, but it is only one of several factors that can mean life or death for transplant patients. A hospital's organ-acceptance rate by itself does not tell a patient anything about the quality of a transplant center.

Here's why:

After UNOS' computerized matching process identifies and ranks suitable recipients, the organ is offered, in order of priority, to the transplant centers whose patients appear on the list. Each center's transplant team carefully considers the organ for its patient and must either accept or refuse the organ within an hour.

The decision is based on many factors, including the donor's medical history, the severity of the potential recipient's illness, the distance between the donor and the center, and how quickly the transplant team can be assembled to perform the procedure.

Because the organs are viable for limited periods, every detail must be considered when the medical and logistical feasibility of the match is being determined. It is not unusual for the first center on the list to refuse the organ, for any of the reasons mentioned above. When this happens, organ-placement specialists call the next center on the list until the organ is placed. The cold reality is that accepting or turning down an organ is a normal part of the organ-matching process.

Some centers, for instance, specialize in pediatric heart transplants. They are more likely to refuse organs because of their size. Other centers might concentrate on the research and care of liver patients with very rare blood types or other constraints that make them difficult matches. These centers' acceptance criteria are more stringent than those of other centers, and their acceptance rates, therefore, will vary considerably.

A transplant center's circumstances must be considered to fully understand organ-acceptance rates. Information that does not take these circumstances into account might give completely inaccurate impressions about the quality of the transplant program.

UNOS provides other information to help patients choose transplant centers that meet their needs. A report titled "Center-Specific Graft and Survival Rates" contains center-by-center survival rates compared with risk-adjusted computations for every transplant center in the country. UNOS also has a toll-free phone number (888-TXINFO1) and a site on the World Wide Web (http://www.unos.org) where detailed statistics on organ donation and transplants are available.

This week, the board will consider how we can best address the need for building the public's trust. Patients have the right to know whether a facility providing a transplant is able to accept suitable organs when available. Likewise, the public has the right to be assured that the system works.

Walter K. Graham is the executive director for the United Network for Organ Sharing, based in Richmond, Va.

Pub Date: 11/09/97

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