The American
Society of Transplantation (AST) strongly supports efforts
to promote greater public awareness of the national need
for organ and tissue donation and also supports initiatives
which seek to enhance the opportunities for all patients
in need of such therapy, in a manner as fair and efficient
as possible. Currently, there are more than 58,000 people
waiting for a lifesaving donor organ, and at present, organs
are far too few to meet this need.
On April 2,
1998, the Secretary of the Department of Health and Human
Services (HHS) issued a final rule (42 CFR, Part 121) addressing
the governance of the Organ Procurement and Transplant Network
(OPTN).
Since that time,
Congress, the Administration, the transplant community, and
several State Legislatures have vigorously debated the potential
positive and negative impacts of the HHS final rule on our
nation's current system of organ procurement and allocation.
This debate has resulted in:
- Congress delaying the implementation
of the HHS final rule (through the Fiscal Year 1999 omnibus
spending bill - Sec. 213 (b)(1)) for one year and mandating
a study by the Institute of Medicine;
- Several Members of Congress introducing
freestanding legislation seeking to delay and/or amend the
HHS final rule; and
- A variety of State Legislatures
introducing and passing legislation to confine the sharing
of organs to only State residents and prevent such organs
from leaving the State.
The AST believes that the original
legislative intent of the National Organ Transplant Act of
1984 was to create a national system serving all of the citizens
of the United States. Such a system would ideally distribute
organs according to sound medical criteria, and not solely
on the basis of political boundaries. Under the present system
of regional and national organ sharing, 23% of pancreata, 32%
of kidneys, 33% of livers, 32% of hearts, and 41% of lungs
were transplanted into recipients living outside the state
or region in which the organ was procured. It is also important
to recognize that just as organs need to cross state boundaries,
patients should also be free to seek medical therapy outside
of their state of residence. Indeed, according to the most
recent data collected by the OPTN/Scientific Registry, 17%
of kidneys, 27% of livers, 29% of hearts, 31% of pancreata,
and 39% of lungs were transplanted into individuals coming
to the transplant center from outside the state. Overall, 30%
of all solid organ transplants were performed as a result of
donations that occurred in out-of-state hospitals.
While the AST understands
some States have sought legislative remedies to preserve and
protect their
own local organ recovery efforts, the AST believes that the
58,000 U.S. citizens in need of organs will not be effectively
served by a "patchwork" of different State laws -
creating walls and barriers that will likely prevent many lives
from being saved. For example, patients with advanced liver
disease classified as Status 1 (the highest priority) require
emergent transplantation or they will not survive. These patients
are critically dependent upon the wide regional sharing arrangements
currently in place. The State laws, which prohibit livers (or
other organs) from leaving the State, would prevent this sharing
and reduce the chance for the gift of life. The propagation
of such laws would work to the detriment of a progressively
greater number of citizens and would lead to needless loss
of lives. We must take care that proposed solutions for a few
do not become problems for many others. Only by working together
will we be able to refine and create a system that works for
not only some States and regions - but for all patients and
their families in all fifty States.
