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Sending organs to distant centers may discourage donations

December 11, 1996

WASHINGTON (AP) _ When relatives agree to donate organs from a dead family member, they expect them to benefit someone in their own community and not patients in some distant city.

So say some experts who support the policy by the United Network for Organ Sharing to give top priority to patients at centers near the donor site instead of having a national list that favors the sickest patients no matter where they are.

Other experts, and some patient groups, say the local preference policy is unfair and causes some distant critically ill patients to die while less sick local patients receive the precious transplants.

The arguments were made Tuesday at a public hearing where advocates for patients also criticized a UNOS decision last month that people suffering from long-term liver failure of the sort often seen in alcoholics and drug addicts no longer would be first in line for new organs.

But UNOS President James F. Burdick announced at the hearing that critically ill patients already granted the highest priority status would be ``grandfathered in″ and would not fall to the second tier of priority.

The hearing was convened by the Department of Health and Human Services, which is evaluating how UNOS has exercised its authority to distribute donated livers.

UNOS supporters said the organization’s policies help maintain smaller transplant centers throughout the country and encourage more families to donate the organs of deceased relatives.

Dr. Anthony D’Allesandro, a transplant surgeon at the University of Wisconsin, Madison, said his hospital runs the most successful organ donation effort in the country and part of the reason is that the organs are used locally.

``Is it fair in New York, where they have a very high incidence of liver disease, to deny a patient a transplant in another part of the country so the high incidence of liver disease in New York can be taken care of?″ asked D’Allesandro.

Using organs in centers near where the donors’ families live encourages donation, he said.

Hundreds of volunteers and health care professionals work hard to encourage organ donations, D’Allesandro said, and if the organs are used locally ``they see the results right there. It is not as tangible if it is somewhere else. ``There is a feeling that donations would be hurt by sending livers″ to distant cities.

Dr. J. Steve Bynon, director of the liver transplant program at the University of Alabama, Birmingham, agrees.

``Local utilization of organs increases procurement,″ said Bynon. He said health care workers can talk to the recipient and see the results of their efforts.

Some patient advocacy groups and relatives of patients, however, say donated organs should be regarded as a national resource, available to the sickest patient anywhere.

``The general public doesn’t care where an organ goes,″ said Charles Fiske of Brookline, Mass., whose daughter received a liver in 1982. ``The public wants that organ to go to the sickest patients, wherever he is.″

Otherwise, he said, people may get the sense that the system favors some patients.

A letter defending UNOS and signed by 22 senators was sent Tuesday to Donna Shalala, the HHS secretary. The letter expressed ``serious concern″ about HHS plans to ``formulate and impose a national liver allocation policy.″ It praised the UNOS process as ``fair, open and representative″ and asked that it be left intact.

UNOS holds an HHS contract to control liver allocation nationally.

Officials said Shalala will determine if any government action is needed and could recommend new guidelines.

Speakers on both sides of the issue at Tuesday’s hearing agreed that the fundamental problem is that there are too few livers for too many patients. About 7,200 Americans need new livers annually and last year there were only 3,922 transplants. About 800 patients died in 1995 while on the waiting list.

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