I wish to reply to Avram Goldstein's July 27 Metro article, "Maryland Patients Face Longer Waits for Kidneys." No one wishes to disadvantage any patient based on his or her geographical area. Cadaver kidneys for transplant are a scarce commodity. This issue underscores the problems faced in allocating this national resource. The kidney transplant community attempts to balance the need of the patient who waits a long time on the transplant list with the patient who has an opportunity to receive a well-matched kidney, which offers better long-term organ survival. Because of the number of transplant centers throughout the United States, this inequality is equally diffused.

Unfortunately, the Johns Hopkins University and the University of Maryland medical system have been aggressively recruiting patients from outside their region. These large waiting lists have resulted in an increased number of well-matched kidneys being brought into those medical centers for transplantation. For every kidney imported, there is a kidney owed back to the region that willingly sent the kidney out for transplantation. Over several years, the organ procurement agency that supports the Maryland region has not been able to repay those other regions. Now, a moratorium on importing kidneys for patients waiting on these two lists is being imposed.

Patients who came from outside the state of Maryland to be listed at the University of Maryland and Johns Hopkins University will not be affected by this moratorium. Those patients will be able to return to their regional transplant centers, where they will be listed for organs. Marylanders who do not have the opportunity to travel outside the area will be disproportionately burdened by this moratorium. In effect, the University of Maryland Medical Center and Johns Hopkins University have not faithfully served their patient population.

Over several years, the United Network for Organ Sharing member transplant centers have watched as these centers have increased their number of kidneys owed back to other regions. Now, because this number has gotten so large, this moratorium is instituted. It is not intended to punish Marylanders awaiting kidneys but was instituted to repay those regions of the country that have willingly offered the transplant centers of Maryland kidneys for patients who are not from Maryland.

THOMAS R. McCUNE, M.D.

Norfolk

The writer is medical director of the Renal Transplant Program at Sentara Norfolk General Hospital.