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Editorial: Thompson and transplants

The HHS nominee should hew to a national policy

Wednesday, January 03, 2001

President-elect Bush completed his Cabinet-making yesterday, adding the long-promised Democrat -- current Commerce Secretary Norman Mineta, who will move to the Transportation Department -- and generally keeping faith with his promise to be a uniter, not a divider. (The exceptions are Mr. Bush's controversial nominees for attorney general and Interior secretary.) Now it is up to the Senate to scrutinize the nominees.

One nomination, that of Wisconsin Gov. Thommy Thompson to be secretary of health and human services, involves matters of life and death. Gov. Thompson is best known for his state's welfare-to-work initiatives, but as secretary of HHS he also will be responsible for health policy. And on one issue his record is troubling. The governor has been a vocal opponent of the "sickest first" approach to the distribution of human organs for transplantation.

Under HHS Secretary Donna Shalala, new rules have been promulgated to move organ allocation away from a regional model -- in which organs are directed to recipients within a geographical area -- to a national model.

The new rules represent a victory for patients in general over a pathological parochialism. Under the regional system, desperately ill patients are kept waiting -- or die -- while organs that could be expeditiously transported go instead to "local" recipients.

Nevertheless, "sickest first" remains controversial (including, unfortunately, in the U.S. Senate).

The new policy is championed by national transplant centers like the University of Pittsburgh, but has been resisted not only by politicians like Gov. Thompson -- who filed suit to overturn the rules -- but also by the private agency entrusted by the federal government to oversee organ allocation.

That agency, the United Network for Organ Sharing, recently signed a new contract with the federal government that requires UNOS to embrace the "sickest first" policy. But UNOS has been dragging its feet in moving to a national system, focusing instead on a study of the potential effect of a new patient ranking system on liver transplantation.

The last thing UNOS needs is a new excuse to go slow on overhauling the allocation system. Secretary-designate Thompson should not provide one.

As governor, he arguably had a responsibility to vindicate the interests of transplant candidates in his own state. As secretary of HHS, he will be responsible for the well-being of patients throughout the United States. Accordingly he should follow Secretary Shalala's lead and support "sickest first."

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