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Editorial: Transplant triumph

'Sickest first' policy finally gets the green light

Wednesday, November 17, 1999

Thanks to a push from the Clinton administration, a new system for distributing organs for transplantation will be implemented by the beginning of next year.

That's just about two years after the change was first proposed but several months earlier than opponents thought they could finagle. The breakthrough came when Health and Human Services Secretary Donna Shalala went to Capitol Hill last week to fight for the new rule.

Under the plan, organs would be much more widely shared than is the practice currently. Under the present system, the nation is divided into 62 local areas and 11 regions. Organs made available for transplantation go first to the sickest people within the area and then within the region. Only if there are no compatible recipients locally are the organs offered nationally. The result is not only unfair, with people in some parts of the country waiting years and in others only weeks, but it also is an inefficient use of these scarcest of medical resource.

After extensive hearings, Ms. Shalala recommended a national distribution system giving the priority to the sickest patients regardless of geography. But Congress passed a moratorium delaying implementation by 18 months and calling for a scientific study of organ distribution. The research, done by the National Academy of Science, concluded that there are indeed efficiency and fairness problems with the system operated by a private contractor, United Network for Organ Sharing. It called for a much broader sharing of organs, but not on a completely national scale as HHS had proposed.

Ms. Shalala took those findings into consideration in calling for implementation of a more national system to take effect this fall. Congressional opponents, who largely represent smaller transplant centers that will be hurt by the rule change, tried to delay the effective date for a minimum of four months. With the administration's efforts, that was reduced to six weeks.

The issue became an administration priority because it was rightly seen by Ms. Shalala as a matter not only of basic fairness but also of life and death. But this is not the end of the story.

The proposal gives UNOS until February to come up with the precise details of the new distribution system. If the plan does not meet the approval of the secretary, she has the authority to write the final order herself.

At the same time, some legislators will try to pass a law stripping HHS of that power and re-establishing UNOS as the final authority.

Those who favor a much broader distribution of organs must not let down their guards and count the battle won. And advocates in a position of some power, like Pennsylvania Sen. Arlen Specter, must be as committed as the administration is to see that justice prevails.

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