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Specter won't give up on transplant rule changes

Saturday, December 04, 1999

By Christopher Snowbeck, Post-Gazette Staff Writer

U.S. Sen. Arlen Specter says he is not giving up on an oft-delayed proposal to change the way transplant organs are allocated among the nation's hospitals, an initiative that officials at the UPMCHealth System say would create a fairer allocation system.

The current system gives priority to patients at transplant centers near a donor, rather than to sicker patients at hospitals further away. Specter and U.S. Sen. Rick Santorum, both R-Pa., convened a hearing on the matter yesterday at the Allegheny County Courthouse.

This fall, Health and Human Services Secretary Donna Shalala issued new regulations that would give priority to the sickest patients first, but Congress has delayed implementation until next year.

After yesterday's hearing, Specter said he would consider action that would address concerns that the new rules give Shalala too much power in allocating organs if it would clear the legislative roadblocks to implementation.Under the proposed rules, ,, the United Network for Organ Sharing, a Richmond, Va.-based contractor that runs the nation's transplant network, would forward a new plan for allocating organs to the sickest patients first. Shalala would have to approve it.

Specter and other proponents of the change say the current system unfairly creates variations in the amount of time patients wait for organs.

Patients at hospitals in Massachusetts wait, on average, 569 days for a transplant, Specter said at the hearing, while those in Kansas wait only 12 days. Patients at Pennsylvania centers wait an average of 237 days for a liver, the sixth-longest wait in the country.

But Howard Nathan, director of the Gift of Life Donor Program in Philadelphia, the organ procurement organization for the eastern half of the state, defended the current system. He testified that the disparities in waiting times are much smaller when looking at how long the sickest liver patients around the country -- those called status 1 and status 2a patients -- wait for an organ, Nathan said.

Dr. Jorge Reyes, a transplant surgeon at Children's Hospital, disagreed, saying that significant differences exist in waiting times even for status 1 and status 2a patients.

Nathan also said that many of the organs donated cannot be transported fast enough to make national sharing of organs feasible. One-third of the organs procured by his organization are from so-called "expanded donors," meaning the donors are older, have a history of hepatitis or are non-heart beating donors. These organs, which previously were not even considered for transplant, cannot always be effectively transported across the country, meaning some organs broadly shared might end up being wasted, he said.

The proposed regulation is flexible enough that it makes allowances for allocating "expanded donor" organs that might not make a long trip, testified William Raub, science advisor for the Department of Health and Human Services.

Last month, Specter believed he had brokered a bipartisan agreement that would allow the new regulation to go into effect in January. But Republican leaders subsequently passed a 90-day delay in implementation, giving congressional opponents an opportunity to block the regulations next year.

Specter said he is prepared to join Santorum in leading a filibuster against any further delay, but the chances of the changes actually being made are unclear. He said repeatedly at yesterday's hearing that congressional opponents of the new regulation are driven solely by the financial interest of the transplant centers in their states.

"They are destroying the integrity of the system," Santorum said. "It has turned into too much of an economic football."

Specter acknowledged that the rule change he and Santorum support would likely benefit transplant centers in Pittsburgh, but during the taping yesterday of KD/PG Sunday Edition he said that was a coincidence.

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