Penalizing hospitals for being too successful Kidney transplants: This week's agreement doesn't address larger problems of organ allocation system.

November 21, 1998

IN THE SHORT RUN, the agreement reached this week between the Maryland Transplant Resource Center and a national organ-sharing network is good news. Patients awaiting kidney transplants won't become victims of an internecine battle that would have forced them to the bottom of the national waiting list for donor organs.

And if -- as the agreement calls for -- there's increased local attention paid to the pressing need for organ donors, all of us will benefit.

Unfortunately, a bigger problem has yet to be adequately addressed.

The Baltimore area's two hospitals with national reputations in this specialized area of medical research remain in a Catch-22. Because of their success rates with kidney transplants, they are being penalized unfairly.

Earlier this year, the United Network for Organ Sharing (UNOS), the nonprofit agency that holds a federal contract to enforce organ allocation policy, threatened sanctions against Maryland's transplant programs, citing the imbalance of the number of kidneys that enter the state over the number that are shipped elsewhere for transplant. That surplus is directly linked to the skill of surgeons at Johns Hopkins and the University of Maryland hospitals in taking kidneys rejected by other medical centers and successfully transplanting them. That, of course, increases the number of gravely ill patients who seek treatment here.

Further complicating the situation is the inordinate influence within UNOS of several states that favor allocating organs based on geography rather than medical need. Speaker-elect Bob Livingston of Louisiana is championing their cause in Congress, which recently approved a one-year moratorium on implementing federal needs-based system.

Until the long-term situation is resolved to ensure Baltimore's transplant centers aren't penalized for their excellence, patients awaiting transplants can take little comfort.

Pub Date: 11/21/98

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