ORGAN DISTRIBUTION: States Vow Opposition To New Rules

      Louisiana, South Carolina, Wisconsin and Oklahoma oppose a federal proposal to change how donated organs are distributed. The AP/Chicago Tribune reports that "[i]n a direct challenge to a new federal policy, states are passing laws ordering that organs donated at home stay at home if there's a patient who could benefit." Such laws stand in direct opposition to the proposed federal guidelines, which would essentially eliminate the geographic-based distribution of organs in favor of a national system favoring the sickest patients, no matter where they live. So far, "[f]our states have passed laws effectively erecting walls around their states, ready to challenge HHS in court," and "at least four other states have considered similar laws" (7/15). Today's Tulsa World takes a close look at Oklahoma's opposition to the new distribution policy. Dr. Doug Ensley, medical director of the heart transplant program at Tulsa's St. Francis Hospital, said, "A very high proportion of the patients that have gotten heart transplants at St. Francis come from a low-enough socioeconomic bracket that if they had to go out of state to get a transplant, they never in a million years would have been transplanted. And I suspect that would be true for the liver and kidney programs" (Winslow/Myers/Ford, 7/15).

AMA Wants To Refocus Debate
      At their meeting last month, members of the American Medical Association's House of Delegates directed the organization's board of trustees "to examine the complex issue" of how best to distribute donated organs in the United States. The move was driven by the federal government's effort to impose new distribution regulations "that would give priority to the sickest patients based on standardized medical judgment and common medical criteria -- no matter where they live or at which transplant center they are awaiting treatment." But in directing the AMA board to study the issue, the delegates stressed that the controversy over the new HHS guidelines "misses the problem's root cause: the continuing shortage of organs available for transplantation." Revamping how organs are distributed "will not necessarily increase the number of people receiving transplants," said Dr. Phil Berry, a past president of the Texas Medical Association and former board member for the United Network for Organ Sharing. Berry added, "We've been looking at the problem from the wrong end of the telescope. We always look at how to better distribute the organs we have, instead of how to increase organ donation. It's time for our AMA to do the right thing and get behind organ donations and let the doctors of America be out front and help solve this problem" (Stapleton, American Medical News, 7/13 issue).

Short-Sighted Reform?
      Two economists writing in the Washington Times take issue with the new HHS organ distribution guidelines, arguing that "a sickest-first policy ... ignores the impact that today's decision has on the number of deaths over time." Noting that sicker patients often have shorter post-transplant lifespans, Charles Carlstrom and Christy Rollow write that current UNOS guidelines "reflect an attempt to balance the competing concerns of equity and efficiency." They argue that the new HHS rules "threaten to skew the balance" in the current "regional" system which often ensures that "healthier patients" get scarce organs instead of sicker patients with poorer prognoses. "The debate needs to be refocused. A squabble about winners and losers has intruded on what we should be discussing: how to design an efficient system that best uses our extremely scarce and valuable supply of organs. While fairness is an appropriate concern when discussing organ transplants, we must guard against the unfairness of a transplant policy that allows needless deaths and focuses on less relevant concerns. A national transplant policy should have exactly one goal -- saving as many lives as possible," they conclude (7/12).