Playing politics with life-saving transplants

Punitive vote: Marylanders waiting for kidneys will suffer if state is denied donor organs.

July 25, 1999

HERE'S a prescription that should always be followed: Don't mix medicine with politics. Yet that is what has happened with the nation's kidney transplant centers. The results could be disastrous -- even lethal -- for many of the 1,600 Marylanders on the state's transplant waiting list.

Maryland's predicament is ironic. Its two teaching hospitals -- Johns Hopkins and University of Maryland Medical Center -- are among the nation's best at organ transplants. Their success draws patients from other states. The result is that the two Maryland hospitals import far more kidneys than they export to other transplant centers. That's become a problem.

Smaller hospitals, which want to do more of their own high-prestige organ operations, have lobbied the group that enforces transplant policy for the federal government -- the United Network for Organ Sharing (UNOS) -- and convinced the group to penalize Hopkins and University.

Those really being penalized -- and put at risk -- though, are the transplant patients at the two Baltimore hospitals.

Starting this winter, patients waiting for a perfect kidney match at Hopkins and University will go to the bottom of the national list. This means some patients who have finally made it to the top of the transplant list after three or four years will be coldly shoved aside. It could be a death sentence.

This is a cruel, calculating move borne out of medical politics, not good medicine. Superior transplant centers are being punished for doing their jobs too well.

UNOS even went so far as to suggest that Hopkins and University turn away patients so smaller centers can get more transplant work. That would be unconscionable when lives are at stake.

A panel of the Institute of Medicine at the National Academies of Sciences studied UNOS' organ allocation system and found it needed "significant improvements in both its fairness and its effectiveness."

In a report issued last Tuesday, the committee noted that transplant decisions must be based firmly "on sound medical science" -- not on giving all hospitals a piece of the action. It also found that transplant centers such as Hopkins and University that serve large populations have the lowest mortality rates and provide the best access for patients most in need of transplants.

Unless UNOS reverses its decision, Maryland's political leaders in Washington should step in, or state transplant leaders should ask a judge to stop this clearly discriminatory action.

The UNOS sanction cannot be allowed to stand. Public policy should actively encourage the best organ transplant centers in the nation to do more, not fewer, operations.

Pub Date: 7/25/99

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