Change Sought In How Donor Organs Allocated Government Wants Sickest Patients To Go To The Top Of A Nation-Wide Waiting List

With more than 4,000 Americans dying each year while waiting to receive an organ transplant, the Clinton administration Thursday said it intends to dismantle the 14-year-old regional system for distributing donor organs and replace it with one in which patients who are sickest will go to the top of the waiting list, no matter where in the country they live.

The announcement, issued in a carefully worded letter from Health and Human Services Secretary Donna Shalala, is a step toward settling a divisive three-year-old debate about how organs - and in particular livers, which are in especially short supply - should be distributed. She wrote the letter to 89 members of Congress who had written to her on the issue.

But Shalala’s plan drew immediate criticism from the United Network for Organ Sharing, the independent agency that governs the current system, in which organs are first offered to patients who live closest to the donors.

“The transplant community overwhelmingly supports the idea of allowing the organs to be allocated within the local area, because every local area has a shortage and people are dying everywhere in the country,” said Walter Graham, executive director of the network. “Every person who gets a transplant desperately needs it, and the sad fact is that there are not enough to go around.”

However, the group acknowledged that in some regions of the country, the wait is much longer than in others. In Michigan, Indiana and Ohio, for instance, the wait for a liver was 370 days in 1995. But in Louisiana, Mississippi, Florida, Georgia and Alabama, the wait was 96 days.

This means that patients who live where the wait is shortest may receive organs even if they are not as ill as those who live in areas that have longer waits. “In the worst case,” Shalala wrote, “patients die in areas where waiting times are long, while at the same time organs are being made available to less ill patients with shorter waiting times.”

Moreover, she noted that while current technology permits organs to be kept alive long enough to be transported across the country, the current allocation scheme “has so far failed to take full advantage of that opportunity.”

The current system was established in 1984, when Congress adopted the National Organ Transplant Act. The law, which was designed to create a national system that would distribute organs fairly, called for a network of nonprofit, independent organ procurement organizations to obtain organs from donors and distribute them to local hospitals. There are 63 such organizations in the country, all are members of the United Network for Organ Sharing, which holds the federal contract to administer the program.

The distribution system works this way: When an organ becomes available in one of the 63 areas, it is offered first to a patient in that area. If no patients are in need, the search extends to the surrounding region; the country is broken up into 11 regions. If no regional patients are in need, the organ can go to anyone in the nation.

In 1996, according to Shalala, more than 60 percent of livers were used in the local area. More than 50 percent of these livers, she said, went to patients who were not sick enough to be hospitalized. During that same year, nearly 400 of the 953 patients who died while waiting for transplants were hospitalized when they died.

In her letter, Shalala said she feels strongly that the current network should continue to administer the transplant program. But she said the department intends to require the network ‘to develop the specific, medically sound policies’ for achieving her goal of the equitable distribution of organs.

An estimated 55,000 people are on the national organ transplant waiting list today, up from 16,000 ten years ago, according to Shalala.

On average, Graham said, 4,000 people receive liver transplants in the United States each year, but there are 9,500 people waiting for liver transplants for 4,000 livers, according to Graham of the organ sharing network.