ORGAN ALLOCATION: Specter Vows He Will Not Give Up
At a hearing last Friday, Sen. Arlen Specter (R-PA), and Sen. Rick Santorum (R-PA) discussed concerns that the new organ allocation rules would give HHS Secretary Donna Shalala too much legislative power, the Pittsburgh Post-Gazette reports. Specter said that he will not relent in getting the new system implemented, which he believes to be fairer. This fall, Shalala issued a new plan that would give sicker patients, rather than patients who are geographically proximate to a donor, a higher priority for transplants. But Congress has delayed implementation until after January, giving congressional opponents an opportunity to thwart the regulations. Specter thought that he had negotiated a bipartisan deal for implementation to go forward in January, but Republican leaders passed a 90-day delay anyway. Specter has indicated that he will join Santorum and filibuster against any additional delay, though the odds that there will be a delay are uncertain. Specter accused opponents of the new system of being "driven solely by the financial interest of the transplant centers in their states." Santorum added, "They are destroying the integrity of the system. It has turned into too much of an economic football." Officials at the Gift of Life Donor Program, a procurement organization in eastern Pennsylvania, do not agree. The organization's director, Howard Nathan, supports the current system, saying that waiting-time disparities are smaller when looking at the wait times for the sickest liver patients around the country. He also fears that some organs might not be usable after a longer trip, effectively wasting organs that might have been used in patients closer to the donor (Snowbeck, Pittsburgh Post-Gazette, 12/4).
Problems Beyond the Political
But even as politicians wrangle over legislation and regulation, the overwhelming need for organs in the U.S. continues to increase, reports the Los Angeles Times. Organ transplants have doubled in the last decade, but the waiting list has tripled. Every day, 12 patients die waiting. The federal government has attempted to ease the shortage by requiring hospitals that receive Medicare payments to report every death to procurement centers that can then identify suitable donors and approach their families. But even as more donors are found, the shortage will continue to worsen as doctors become more proficient at doing transplants and more patients becoming eligible. Advances in medicine and technique allow many who would have been unable in the past to now undergo transplants, at a time when advances in automobile and motorcycle safety have reduced head trauma deaths, once a significant donor source. Also, many individuals who indicate their willingness to donate, neglect to tell their families of their decision. In many cases, families who are asked to donate loved one's organs refuse. Experts say that if families were simply aware of the decision to donate, the shortage could be eased, especially since procurement organizations will not take an organ without the family's consent. A study sponsored by the Agency for Health Care Policy and Research discovered that 43% of families had discussed donation, and only 25% were aware of whether their loved ones had donor cards. Ninety-five percent reported that knowing of their relative's donation decision would have influenced their final decisions substantially. Organ procurement centers, too, are often not told when a death occurs, and therefore are unable to discuss donation with the families of the deceased. Lawmakers hope that a new federal statute will address this issue, by "shifting responsibility from the hospital to local procurement organizations." Experts agree that even with these measures, the 65,000-person waiting list will never be eliminated. Every year, 15,000 potential donors die, but only 5,800 provide organs. Those donors provide nearly 17,000 transplants, but if all 15,000 donated, nearly 49,000 transplants could take place. The Department of Health and Human Services is campaigning for public awareness and has set a goal to increase donations by 20% (Cimons, Los Angeles Times, 12/05).