Patience

Organ donations should be distributed nationally

For patients facing the painful wait for organ transplants, a recent decision by U.S. Secretary of Health and Human Services Donna Shalala may offer new hope. Last Thursday, the Clinton administration ordered the private network that distributes organs nationwide to be revamped. The move's intent is to prevent distribution problems that crop up due to the demand and supply of different organs in various regions. While the new system would likely benefit thousands of patients across the country, the administration should let the medical community guide the new distribution mechanism's development.

Under the present method of organ distribution, the United States is divided into 63 local areas. Organs are first made available to patients within the area in which they are donated. If there is no need for the organ in that area, it is then made available to anyone within the area's region - of which there are 11 nationwide. Finally, if there is still no need for the organ, it is offered to patients at the national level.

As a result of this mechanism, gross variances exist in the demand for organs in adjacent locations. For example, patients in San Francisco often wait two to three years for a much-needed transplant, but in nearby Sacramento, the waiting period can be as short as a few months. In addition, the system creates the opportunity for an unfair economic-based advantage to ensue. Those who can afford to relocate when dire medical conditions strike have an unfair advantage over lower-income, but equally ill, patients. The present situation makes geographic location as great a factor as health in determining whether or not a patient will have an equal chance to survive - a serious problem that should be rectified.

Part of the plan is that the organization that manages the current network - the nonprofit United Network for Organ Sharing - will develop the new system. But Shalala has ultimate veto power over the implementation of the new system. If, after the five months the organization has been given to create a new system, Shalala dislikes it, she holds the power to dissapprove it - negating all of the network's efforts. Politics should not play such a large role in guiding medical policy - the government should accept the suggestions of the network and the medical community and not pretend to be wholly knowledgeable when making such important decisions.

The program's intent would also implement a universal system to determine who has the greatest danger. Unlike the present system where individual hospitals rank patients' needs, this change would allow equally sick people on opposite ends of the country to have the same chance at getting a needed transplant.

The number of patients waiting for donations in the United States is staggering. Under the current system, though, more than 10 people per day die because they cannot get the organ they need. The new system has the potential to ease some of the waiting and demand that plague patients in need of organ donations - the Department of Health and Human Services should consult the medical community and implement their recommendations.

04-01-98