Penalizing the success of transplant program Organ donations: Kidney 'debt' and punitive measures could deprive patients of lifesaving procedures.

June 12, 1998

LIFESAVING operations that are now almost routine in organ transplant surgery are little short of miraculous. But the dilemmas created by the mismatch between too few donors and too many potential recipients are agonizing.

In Maryland, home to two "centers of excellence" in organ transplants, patients wait 2.6 times the national average for a new kidney.

Even so, those centers, the University of Maryland and Johns Hopkins, could face sanctions from the United Network for Organ Sharing (UNOS), a private group that regulates organ distribution, because the state has received far more kidneys that prove a "perfect match" for patients here than it has contributed to the national pool.

The idea of punitive sanctions on leading transplant centers tTC such as University of Maryland Medical System is absurd. Such capricious rationing of health care would be a life-threatening blow to patients waiting for a kidney.

Maryland transplant centers could also be damaged by federal directives ordering UNOS to rearrange organ distribution so that waiting time, not geography, is the primary factor in determining who gets an organ. The directive from Health and Human Services Secretary Donna Shalala is well-intentioned but heavy-handed.

UNOS, with a virtual monopoly over organ allocation, has an obligation to review and revise its procedures to ensure the best use possible of scarce resources. For instance, transplant surgeons note that with new generations of drugs to prevent organ rejection, the concern about "perfect match" kidneys is no longer as great.

Perhaps the system of giving precedence to perfect-match recipients -- thus creating "debts" like Maryland's -- needs a thorough review.

There is no simple solution to the shortage of organs for transplant. Action on several fronts could help, including educating families about the value of organ donations.

Secretary Shalala's directive to "normalize" organ allocation based on waiting time rather than geography represents to many critics a dangerous level of federal meddling. Yet without some prodding, UNOS seems reluctant to implement any change at all.

Maybe the threat of federal action will prompt UNOS officials to implement reasonable modifications, such as moving toward a system based on regional allocation of these lifesaving organs.

Pub Date: 6/12/98

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