Better Organ-Transplant Policy

One of the most wrenching decisions in medicine is who gets an organ transplant and who will die for lack of one. It’s estimated that fewer than half of the 55,000 Americans now on waiting lists for kidneys, livers, lungs and other organs will receive transplants. Last week, Health and Human Services Secretary Donna Shalala proposed replacing the present system, which offers organs first to patients in the region where they are donated, with a fairer system based on national need.

The current system was designed in 1984, when some organs could not be transported far without risk of damage. Nowadays, improved organ transplant technologies mean there is no reason for geographic inequities that favor patients in smaller cities, where waiting lists are shorter. Waiting times run two to three years in San Francisco, for instance, but under a year in Sacramento.

Some transplant advocacy organizations object to Shalala’s proposal that organs be given to patients “in greatest medical need.” The sickest patients, they argue, are not always the best transplant candidates because of their poor long-term survival rates. Shalala’s plan, however, does not presume to define medical need. It leaves development of fair and medically sound protocols to organ transplant professionals.

Shalala is well within her rights to ignore hospital and transplant groups that simply do not want their selection criteria discussed in public. Public debate is overdue for hard questions like whether a chronic alcoholic should be given a new liver.

The best solution to the scarcity of organs is for more people to sign donation cards and to let their families know their wishes. In the meantime, Shalala’s plan, by inviting open debate, should help surgeons make better use of the limited gifts available.