ORGAN ALLOCATION: HHS Final Revisions Based on Sickness
In a move that may end-bracket the contentious debate over the rules governing allocation of organs for transplant, HHS Secretary Donna Shalala announced Monday a new set of "core policies." The new rules give priority to the sickest patients and establish "a series of criteria that treat all patients by one set of rules, including survivability," USA Today reports. The policies are "intended to lessen the importance of waiting lists, force hospitals to share more information ... and minimize inequities that can lead to heartbreaking medical choices" (Davis, 10/19). The new policy, which relies heavily on recommendations made by last summer's report from the Institute of Medicine, calls for organs to be distributed according to uniform medical criteria established by the transplant community. Dr. Claude Fox, administrator of HHS's Health Resources and Services Administration said, "We think that this is going to improve survival overall. We think the system is going to be better" (Reuters/Washington Times, 10/19).
Concession to UNOS?
The United Network for Organ Sharing, which oversees transplant allocation for the government, had opposed HHS's initial proposal, arguing that the allocation of organs was a "medical decision that should be made by medical experts." UNOS officials also said that the proposed changes would hurt small organ transplant centers, as more organs would be diverted to larger centers with more patients. Based on those concerns, HHS revised the policy, which now calls for organ allocation based on "sound medical judgement." Shalala said that the new policy is designed to "avoid wasting organs and making futile transplants" (AP/New York Times, 10/19). HHS will also establish a new independent advisory committee to provide "guidance for future policies governing organ allocation." UNOS did not review the final policy before it went public (Hostetler, Richmond Times-Dispatch, 10/19).
Transplant surgeons immediately expressed concern over the revised policy. American Society of Transplant Surgeons President Ronald Busuttil said, "The bottom line is that (HHS Secretary Donna Shalala) continues to insist on having the final word on decision relating to the allocation of organs to transplant patients" (McGinley, Wall Street Journal, 10/19). The American Society of Transplantation (AST) applauded Shalala's announcement and urged UNOS to work with HHS to "modernize the allocation system" (AST release, 10/14). Expressing "general support" for the revisions, National Transplant Action Committee (NTAC) President Craig Irwin said, "We believe that the Secretary has shown a great deal of flexibility and has done a superb job in working with the transplant community in the interest of compromise" (NTAC release, 10/18).