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Organ Transplants & Their Allocation

In June of 1988, the State of Oregon determined it would no longer pay for heart, liver, bone marrow, or pancreas transplants for its citizens. Several other states have followed suite, citing that they are using the money normally allocated for organ transplants to pay for procedures that give a better return of health benefits per dollar spent.

The consequence of this decision is that the poor of the wrong states cannot get organ transplants for themselves or their children unless they raise the money themselves. A typical organ transplant costs anywhere from $100,000 to $200,000 - a daunting amount to be raised by one individual.

The question, then, that we must ask ourselves is do we want to live in a country where only the rich have access to a medical procedure that will save their life? Are the poor just "our of luck"??

Transplant debate: Local access 'a myth'

WASHINGTON (AP) - Most liver transplants are performed in a relatively small number of cities, and many Americans live far from transplant centers, an inspector general report concludes.

In a bitter fight over how to allocate scarce organs for transplant, some in the transplant community have argued that new federal policies might wind up denying people access to their local centers. But the new report argues there's little local access to begin with.

''Widespread local access to liver transplant centers is a myth,'' said the report from the Department of Health and Human Services inspector general.

HHS issued regulations last year directing the network that runs the nation's organ transplant program to create new policies for the distribution of organs that would offer organs to the sickest patients first. The current system relies heavily on geography, directing most organs to local patients even if there are sicker ones elsewhere.

Many in the transplant community have been fighting this policy, which Congress put on hold until October. Among other things, they argue that sending all the organs to the sickest patients could jeopardize some programs and force their patients to travel great distances to get transplants.

The report did not examine whether that would happen, although last month, the Institute of Medicine issued a report that found no evidence that greater sharing of organs would close transplant programs.

''In the debate on this rule there was a lot of comment made on the importance and value of local access. The implication often made was that local access often exists,'' Mark Yessian, who worked on the report from the inspector general's Boston office, said Thursday. ''We tried to clarify the situation.''

The report focused on liver transplant programs because liver policy has generated the most controversy.

It found that in 1997, more than 80% of transplants were performed in 35 cities and just 20 centers performed more than half of all liver transplants.

Also, the report said 77 of the nation's 117 liver transplant programs were in cities with two or more centers. At the same time, there were 57 centers that performed fewer than 25 transplants per year.

45% of Americans already live in areas that do not have a local center.

''If you talk to those patients, they'd say it's pretty important for them (to have a nearby center).''

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