On organ transplants, it's location, location, location

April 11, 2000|By Ellen Goodman

BOSTON -- To be frank, it never occurred to me that I have a Boston liver. A Boston accent, yes, I admit to that. But a Boston liver? Or for that matter, a Massachusetts kidney.

I've had conversations with my family about organ donation, but not once did I think of donating my body parts to the nearest over the neediest. We may be parochial in New England, but not that parochial.

Nevertheless, it turns out that this country has long practiced a highly lethal form of health care: medicine by geography.

In the life-and-death business of transplant surgery, more than 60,000 people wait annually for about 20,000 surgeries. About 5,000 die every year on waiting lists.

It turns out that a person in one state or region can literally die waiting while an organ is allocated to a less critically ill patient in another. Organs are too often allocated to the closest person instead of the sickest person.

The best thing you can do for your health if you live in, say, New York, where the median waiting time is 511 days for a liver, is to move to New Jersey, where the waiting time is 56 days. Three little watchwords of transplant medicine are like those of real estate: location, location, location.

Yet the attempt to rationalize this system has resulted in a decade-long wrangle. And the other day, the House of Representatives once again passed a bill that would uphold the local rights to organs. Now only the Senate can put the patient's health before his or her address.

How did we get into a fix where some sort of bizarre states' rights apply to your and my body parts? The "local-first" rules made sense back in the days when organs had a very short "sell" date, if you will forgive the supermarket lingo. You had to use a liver within eight hours, a pancreas within 10 hours, a heart within three.

Preservation techniques have doubled those times. But we still have a balkanized system that distributes organs to 62 local districts first, then 11 regions, only rarely across the nation. The United Network for Organ Sharing, the private agency contracted to distribute organs fairly to patients, seems a tad too concerned with keeping the proliferating and profitable local transplant centers healthy.

For the better part of a decade, the Department of Health and Human Services has been trying to gain some oversight and rationalize rules that would share organs more broadly across larger regions. But the House has cast this as a federal power grab.

The "states' rights" argument that every state has dibs on its "own" organs is strange enough when you consider that $2 billion in annual payments for transplants comes from the federal budget. Last time I looked, Medicare and Medicaid money came out of a

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cf01 body part: our hides.

It's strange too because under the House policy, if I die while visiting Wisconsin, my "Boston liver" would be claimed for a Wisconsinite. Furthermore, even though a lung can't be shipped across various geographic barriers to get to a patient, a patient can cross lines to get to the lung.

Some people can afford to move from, say, Illinois to Wisconsin in search of a shorter waiting list. Some can't. But even if the Senate comes out with a fairer way to distribute organs, there's going to be a legal hurdle.

Already, half a dozen states from Louisiana to Wisconsin have passed what can only be called "state hoarding laws" that keep organs within their borders.

"They're not talking about what's good for the state residents, they're talking about what's good for the state transplant programs." says Dr. John Fung, head of a transplant program at the University of Pittsburgh.

The underlying problem is the gap between supply and demand. As long as organs are a scarce resource, there will be tugs of war. But donors are influenced by the desire to save lives, not local transplant centers.

As someone with a donor card, you can trust me on this. My heart belongs to Boston. But I don't mean that literally.

Ellen Goodman is a syndicated columnist. Her e-mail address is ellengoodman@globe.com.

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