The lamentable politics discussed in the Oct. 23 editorial "An End to Organ Games?" have nearly destroyed the community of organ transplant professionals.

While evidence exists that much of the struggle by individual transplant program leaders to preserve exclusive access to donor organs is financially motivated, money worries alone would not have spawned the open warfare that has replaced reasoned discussion among organ transplant professionals.

Those of us who have fought against the system of allocation for years are heartened by the public attention finally focused on this issue. Change is needed to make the system more fair.

Having said that, I also harbor sympathy for those who have fought change. All of us on both sides of this battle must deal with patients who are dying because of a lack of donor organs. Any change in allocation that threatens to reduce a transplant program's access to donor organs, even if that change evens the playing field, also threatens that program's ability to save lives.

As a transplant surgeon, I have an obligation to do everything I can to save the lives of my patients. As a member of the transplant community, I also have an obligation to ensure the fair and proper stewardship of our scarcest resource. At the root of this battle lies the inevitable contradiction of these two roles.

Physicians who see change in allocation reducing their ability to save lives find little solace in the good that change may cause elsewhere. Ultimately, we are all fighting for the same goal -- to save our patients' lives.


Professor and Chairman

Department of Surgery

University of Nebraska

College of Medicine