ad info

 
CNN.com
  healthAIDS Aging Alternative Medicine Cancer Children Diet & Fitness Men Women
    Editions | myCNN | Video | Audio | Headline News Brief | Feedback  

 

  Search
 
 

 
HEALTH
TOP STORIES

New treatments hold out hope for breast cancer patients

(MORE)

TOP STORIES

Thousands dead in India; quake toll rapidly rising

Israelis, Palestinians make final push before Israeli election

Davos protesters confront police

(MORE)

MARKETS
4:30pm ET, 4/16
144.70
8257.60
3.71
1394.72
10.90
879.91
 


WORLD

U.S.

POLITICS

LAW

TECHNOLOGY

ENTERTAINMENT

TRAVEL

FOOD

ARTS & STYLE



(MORE HEADLINES)
*
 
CNN Websites
Networks image


States' rights or patients' rights? The new politics of organ allocation

by Jeffrey P. Kahn, Ph.D., M.P.H.
Director, Center for Bioethics
University of Minnesota

April 17, 2000
Web posted at: 2:55 p.m. EDT (1855 GMT)

The House of Representatives recently passed legislation that effectively prevents the enactment of governmental rules that would establish a new national system for allocating solid organs for transplant taken from donors after they die. The new system would treat organs as a national resource, with allocation being determined by severity of illness and time on the waiting list, no matter where the patient is in the country. But this would mean that areas of the country with the highest donation rates would see more organs leave their states than come in, making them net exporters of organs. Many states have therefore objected to the new system, and some have even gone so far as to pass their own laws barring organs collected in the state from leaving. Whose rights ought to win out -- statesí citizens and organ transplant centers, or sick patients whose illnesses donít respect state boundaries?

Center for Bioethics

What's your opinion?

Itís geography, stupid

The existing system of organ allocation is regional, with the country divided geographically into a number of multi-state organ procurement organizations (OPOs). Under this system, priority is given first to patients waiting for a transplant within the region in which donated organs are collected. That means that patients have shorter waits for organs like livers in regions that have a higher rate of organ donation, and likewise wait longer in regions with lower donation rates. This has created what some consider an unfair system, in which medical factors (severity of need, time on the waiting list) are only part of what determines how long patients wait for organs, and equally sick patients in the south wait longer than those in the upper Midwest.

Historically, part of the reason for a regional system was that highly perishable organs wouldnít last long enough to allow them to be transported over long distances. But an organ could easily be flown or drove within a smaller region of the country, assuring that they would be transplanted within the small window of opportunity. But with the advent of overnight and even same day delivery services, we now have guarantees that organs will "absolutely, positively be there overnight."

Transplants pay, so hospitals fight for them

A system that was created to accommodate the limits of both the techniques of transplant medicine and the countryís transportation infrastructure became complicated by the realities of medical economics. Organ transplants are both prestigious for hospitals and medical centers, and a profitable part of the business of medicine. This has created a bigger incentive to fly patients to where the organs are collected than to ship organs to the patients, since that would mean that another transplant group would perform (and benefit from) the surgery.

Equal access for all-but only if youíre a frequent flyer

Because of the regional system, transplant patients often rack up many frequent flyer miles. If they can afford to fly to a transplant center to be worked up and agree to return on a momentís notice, patients can list themselves on multiple regional transplant lists, effectively multiplying the chance of receiving an organ. This effectively creates a system by which potential organ recipients can buy greater access to organs, which is certainly outside the spirit of a system that pretends not to consider ability to pay in organ allocation decisions. The federal governmentís proposed national system would dispense with regional variation, multiple waiting lists, and the incentive for states to treat organs like a commodity.

However compelling these arguments may sound, disparities based on geography donít seem to matter if youíre waiting in Minnesota, where your wait is likely to be shorter. But the same patient in Mississippi would have a different perspective on waiting time, and thatís precisely the point. Patientsí lives are no less valuable when we cross state lines, and our organ allocation system needs to reflect this fact or we risk a new kind of war between the states.


The House of Representatives recently passed legislation that effectively prevents the enactment of governmental rules that would establish a new national system for allocating solid organs for transplant. The new system would treat organs as a national resource, instead of rewarding states with higher donation rates by allowing them to transplant patients in their region first. Whose rights ought to win out -- statesí citizens and organ transplant centers, or sick patients whose illnesses donít respect state boundaries?



Post your opinion here.


Visit the
"Ethics Matters" Archive
where you'll find other columns from Jeffrey Kahn
on a wide range of bioethics topics.


"Ethics Matters" is a biweekly feature from the
Center for Bioethics and CNN Interactive.


 Search   

Back to the top   © 2001 Cable News Network. All Rights Reserved.
Terms under which this service is provided to you.
Read our privacy guidelines.