Fairness in Organ Transplants
One of the most wrenching decisions in medicine is which of the 68,000 Americans awaiting organ transplants each year should get them.
Part of the problem would be solved if more people overcame their reluctance to donate their heart, lungs, liver, kidneys or pancreas upon their death; only about 17,000 organs are donated each year, and about 4,000 Americans die annually for lack of a transplant.
But even if donations boomed overnight, a big part of the problem would remain: Congress wants to bar the Clinton administration from proceeding with its sensible plan to reduce inequities in the current organ donation system.
Under the current system, a private government contractor called United Network for Organ Sharing distributes organs within limited geographic areas, some of them better supplied with donor organs than others. Where one lives can be a life-or-death matter. The well-off are also far more likely than the poor to get onto organ waiting lists.
The administration’s plan, implemented just last month, directs the network to devise standardized medical criteria to allocate organs nationally, based on gravity of illness and the prospects that a transplant will be of benefit.
Devising “patient-centered, outcome-oriented measures” like a point system that distributes organs based on “medical characteristics and disease prognoses” was in fact the key recommendation of a major study commissioned by Congress and issued last year by the widely respected National Institute of Medicine.
All this would be undone by Rep. Michael Bilirakis (R-Fla.), author of a bill passed by the House last week and now in the Senate. Bilirakis says that the federal government should not be “determining life-and-death matters” and argues that making organs available nationally rather than just regionally, as is mostly the case now, would discourage local organ donations.
However, the Institute of Medicine study indicates that national criteria would not discourage local donations and affirms Washington’s “legitimate and appropriate oversight role to ensure that reasonable standards of equity and quality are met.”
The federal government imposes basic quality controls on all of its private contractors, and Bilirakis has been unable to justify exempting medical contractors, arguably the most important vendors of all, from such controls, especially given the inequities identified in the Institute of Medicine study.
President Clinton should veto Bilirakis’ legislation if it comes to his desk and proceed with his plan to base organ donations on the scientific discipline of medicine instead of the vagaries of economic and geographic fate.
