WASHINGTON -- After nearly two years of fighting with the Clinton administration over how to distribute scarce donated organs, the network that runs the nation's transplant system has agreed to develop a system aimed at getting more livers to the sickest patients.
The United Network for Organ Sharing said Monday it would expand the geographic areas that guide allocation decisions, allowing a donated liver to travel farther in order to reach a sicker patient.It also agreed to develop a more sophisticated system for ranking patients on the transplant waiting list, so that those in most urgent need of transplants rise faster to the top of the list.
Currently, patients in some parts of the country get transplants much quicker than those in others. That's partly because donated livers are distributed to local patients first, even if a sicker patient needs one in a neighboring area.
More than 4,800 people died in 1998 waiting for transplants. More than 68,000 patients are waiting now, including almost 15,000 waiting for livers.
Hoping to create a fairer system, the Department of Health and Human Services issued rules ordering the network to create a new system to send more of the scarce organs to the sickest patients.
After the rules were issued nearly two years ago, the network and many transplant centers complained they would jeopardize small programs that might lose locally donated organs to larger hospitals in other communities with more of the sickest patients. Anyway, many said, HHS lacked authority to wield final say over policy decisions.
Congress put the rules on hold several times. But the last moratorium is about to expire, and the rules can take effect Thursday.
Once it became clear that Congress would not delay the rules again, the network's board met in special session in Dallas and approved its new plan for submission by Thursday.
"We're pleased. There's no question about that," said John Nelson, who oversees the transplant program for HHS' Health Resources and Services Administration.
The network already had edged a step closer to what HHS wanted, requiring that the very sickest patients get first chance at donated livers within each of 11 regions.
Monday's action moves the network even closer to the HHS, but the network's president, Dr. William Payne, noted that HHS has compromised as well. In October, the agency revised the regulation to make clarifications -- organs need not be shipped coast to coast, for instance, and should not be transplanted into dying patients too sick to benefit.
"Both of us are marching along," Payne said. "If we could all get together and be able to say that we're not fighting on any front, everybody would be relieved."
Specifically, on Monday the transplant network agreed to rank patients based on a sophisticated, objective point system, with points awarded based on symptoms. Those with the most points would be at the top of the list for donated livers.
Under the current system, patients are put into one of four groups. But within the groups, ties are broken simply by how long a patient has been waiting. This new system will consider waiting time, but as a poor indicator of medical urgency it will carry less importance.
The network also plans to submit its current allocation policy to HHS, given that the new policy is not yet completed.
A special committee should complete work on the new policy within six months, network officials said.
Although the HHS regulations affect the distribution of all organs, livers engendered the most controversy, and the network was ordered to submit new policies for livers right away. It has more time for the other organs.
Meanwhile, Congress is working on the larger issues that frame the organ transplant system, including who has the final say over policy decisions. A bill approved by the Commerce Committee last year stripped HHS if almost all its authority over policy. But Sens. Bill Frist, R-Tenn., and Edward Kennedy, D-Mass., are now working on a compromise expected to be introduced next week.
On the Net: United Network for Organ Sharing: www.unos.org
HHS Division of Transplantation: www.hrsa.gov/osp/dot/