ORGAN ALLOCATION: IOM Backs Geographic System
As the October deadline for Congress to overhaul of the organ allocation system to ensure wider sharing among geographic areas nears, the Institute of Medicine yesterday released a long-awaited report that "largely sides with the Clinton administration" (Meckler, AP/Augusta Chronicle, 7/21). The report, which was requested by Congress, found that while the current system is basically fair, it "operates without effective supervision and oversight and could be more efficient in its allocation of livers to those with the most urgent medical needs" (Ress, Richmond Times-Dispatch, 7/21). Reviewing data from about 68,000 patients on waiting lists for livers from 1995 to 1999, the IOM panel said the system is "reasonably equitable" for the sickest liver patients, but that "small organ procurement agencies too often keep available organs within their communities for less-sick patients instead of offering them to sicker patients" elsewhere. The report recommends ending the use of waiting time as a criteria for allocation to less sick patients, instead suggesting a "point system based on medical characteristics and disease prognoses." It also endorses establishment of a federal independent review board to oversee the transplant system. While the United Network for Organ Sharing (UNOS), the agency that administers the nation's organ allocation, had protested that wider sharing would force the closure of some of the smaller of the country's 272 transplant centers, the panel "said evidence was inconclusive" that such closures would occur (Packer-Tursman, Pittsburgh Post-Gazette, 7/21). The panel also found no indication that wider sharing would lead to reduced access for minorities, those in rural areas or the poor, nor would it drive down donations (Otto, Philadelphia Inquirer, 7/21). Although the IOM stopped short of explicitly endorsing the proposed HHS rules, it did recommend that "organ allocation areas" be created that would serve at least nine million people (McGinley, Wall Street Journal, 7/21). "We think that the net result of this will mean that more transplantation will occur in the most medically urgent situations," said Dr. Edward Penhoet, the panel's chair (Stolberg, New York Times, 7/21). Dr. John Fung, director of the Thomas Starzl Transplantation Institute at the University of Pittsburgh, said, "The report affirms what we have been saying for nearly a decade -- that the federal government needs to provide effective oversight to the national transplant system, on behalf of patients and the general public. The HHS regulation needs to be implemented to ensure accountability of the system" (release, 7/20).
Not What We Heard
UNOS officials drew slightly different conclusions, saying the report vindicated the current system enough so that HHS should "back off its position." Margo Akerman, who serves on UNOS' board, said, "It's time for the government to withdraw the regulation, to reconsider it and then to rewrite." But HHS Secretary Donna Shalala said it is time to press ahead (AP/Augusta Chronicle, 7/21). She said, "The bottom line is clear. Changes are needed to better serve patients, and broader organ sharing along with better information are at the heart of the changes that are needed. These have been HHS' specific goals since the publication of our final OPTN rule in April 1998. ... It is our intention now, with the IOM findings in hand, to move vigorously in a cooperative effort to put the final regulation into effect and bring about the improvements that IOM has recognized are so clearly needed. Further delay can only needlessly injure patients" (HHS release, 7/20). Should Congress not act by Oct. 21, it is expected that Shalala will do exactly that. Rep. Michael Bilirakis (R-FL), however, has already "introduced legislation that would give the organ-sharing network, not the government, control over allocation policies" (New York Times, 7/21).