THE FIGHT between the federal government and local organ transplant centers over how better to allocate scarce organs has been a strikingly unsavory application of territorial politics to an area where politics should play no role. This week the Department of Health and Human Services (HHS) published a final regulation -- to go into effect in 30 days -- intended to make organ distribution more equitable. The idea is to even out disparities among the many geographic areas served by the nation's 272 transplant centers, most of which grew up in an era when "harvested" organs needed, for technical reasons, to be used close to home. The varying populations of these regions mean uneven distribution, which, given the shortage of organs, spells death for some 4,000 patients a year for whom an organ cannot be found in time.
Enter HHS, which last year issued a draft regulation calling for the network's contractor, United Network for Organ Sharing, to come up with more equitable criteria based on medical, rather than geographical, status. The organ transplant network, though, fiercely opposed the regulation and persuaded Congress to delay its implementation a year. The network fears the changes would force local transplant centers to close, which in turn would dissuade families from donating loved ones' organs; it also warned of organ wastage because of failed procedures if the sickest patients were invariably transplanted first.
Behind these concerns -- for which a congressionally mandated report from the National Academy of Sciences' Institute of Medicine found no evidence -- is the fear that local centers would close, eliminating the substantial income source they represent for the hospitals that house them. That may explain the otherwise remarkable fact that 10 states responded to the proposed rule by passing laws making it more difficult to send organs out of state. The Institute of Medicine report even cites cases where grieving families willing to donate were urged to sign contracts requiring that organs go only to in-state recipients.
In fact, the report's researchers found no evidence that families care whether organs are used nearby; on the contrary, surveys showed they cared most whether the organs would be fairly used. The report recommends that geographical regions be made larger but that any new system make use of existing transplant networks rather than closing them down, a goal HHS Secretary Donna Shalala says could be achieved under the rule. Opponents of the reforms could still hobble and delay the regulation further as part of the budget appropriation for HHS. Such an action would be an extension of a cynical battle that costs patients' lives as it drags on.