ORGAN ALLOCATION: OIG Report Downplays Geography

      Continuing to fuel the debate over organ allocation, a new report from the HHS Office of the Inspector General finds that liver transplant patients from small communities will not face more hardships as a result of new federal regulations scheduled to take effect in October, the Pittsburgh Post-Gazette reports. The new regulations will require the United Network for Organ Sharing, the agency charged with overseeing organ distribution, to assign organs according to patient need, not geography. "It is a 'myth' that most Americans now have access to transplants virtually in their backyards, according to the report.

Highly Concentrated
      In apparent support for the new HHS policy, the OIG study found that 80% of all liver transplants were performed in 35 cities in 1997 and the 117 transplant centers are "tightly clustered in major metropolitan areas." Although an estimated 45% of the American population lives outside metropolitan areas with transplant centers, 29 of 36 smaller centers perform less than 12 transplants annually, while 20 city-based programs perform over half of all transplants. Many larger cities have multiple transplant centers, including Los Angeles, New York, Chicago, Baltimore and Salt Lake City, while 15 states have none. Although the report does not make any conclusions about the value of smaller centers, it "does show that the assumption about the availability of local access is flawed." In addition, the report indicates that issues like the organ shortage and the expenses of running a transplant center are more likely to affect organ distribution than are federal policies.

UNOS Protests
      UNOS spokesperson Bob Spieldenner took issue with the report, calling it "misleading." He notes that many of the states without transplant centers -- like Maine, New Hampshire and Rhode Island -- can travel to central locations, like Boston, for care. In addition, he asserts that the study does not define what constitutes "outside" metropolitan areas. Although he acknowledges that many transplants are done in larger centers, he says "the number done by medium and small programs is not insignificant," adding that the concern of the transplant community is "that (the new rule) would shut them down." The OIG findings come on the heels of a recent Institute of Medicine report that found "flaws" in the current geographic proximity system (Packer-Tursman, 8/25).