ORGAN ALLOCATION: UNOS Confirms Geographic Disparities
The current organ distribution system results in some patients waiting two months for a new organ, while others are on hold for up to two years, according to a report released today by the United Network for Organ Sharing. The study found that in Pittsburgh, a candidate for a liver transplant waited an average of 721 days during 1994-1996, while a patient in Iowa was typically on hold for just 46 days. And "although the differences are narrower for the very sickest patients," the disparities among states persisted. The AP/Richmond Times- Dispatch reports that the sickest patients in Oklahoma and Oregon waited for a liver transplant for just two days, while similar patients in Maryland waited 16 days. UNOS prepared the report, at HHS' request, in an effort to examine the geographic disparities of organ allocation even as the organization opposes efforts to revamp the organ allocation system. One reason for the geographic disparities was that people in some communities are more likely to donate organs (1/22). Indeed, in Mississippi, the study found that there were 6.4 donors per 1,000 deaths, compared to 34 per 1,000 in Madison, WI. Further, the program's effectiveness, the ethnic composition of the community and the proportion of deaths that are medically appropriate for donation contribute to the differences. In bolstering its case for reform, government officials point to disparities among patients awaiting transplants in New York City and New Jersey, "separated by a state line and a river." In New York City, a patient "would wait nearly twice as long for a new kidney, three times as long for a heart and 10 times as long for a liver" as a patient in New Jersey. HHS Secretary Donna Shalala said, "An organ that could save a life may be literally stopped at the border" (Meckler, AP/Nando Times, 1/21).
Fuel for the Fire?
The government proposes revising the organ allocation system to eliminate the geographic disparities, and giving the sickest patients first shot at the available organs. However, UNOS and HHS "have been fighting for months" to find a solution amenable to both parties. For their part, transplant surgeons contend that the HHS proposal "would lead to more deaths because sicker patients would get more organs, and they are less likely to survive." UNOS President Dr. William Pfaff said, "You can fight about it all day. You're not going to drastically improve anyone's situation by shipping organs across the country" (AP/Richmond Times-Dispatch, 1/22).