States create bureaucratic backlash

Lawmakers challenge new federal policy

Louisiana did it. And so did South Carolina, Wisconsin, and Oklahoma.

And more states will likely follow in an attempt to challenge a proposed federal policy dictating a national waiting list for organs in hopes of equalizing wait times across the country. Four additional states are considering similar legislation while other states have approved resolutions urging the federal agency to reconsider its proposal.

Although the proposed rules from the Department of Health and Human Services won't take effect until Congress approves them, states are taking action to ensure a court challenge will follow.

In effect, states are taking on the larger debate over organ allocation within their own geographic boundaries. At issue is the survivability of local transplant centers.

Supporters of the proposed policy, such as the University of Pittsburgh Medical Center's transplant program, argue that the state laws don't take into account the fact that many people leave their states of residence to seek transplants. Conversely, opponents say they are acting in the best interests of the in-state centers that provide care to those who can't afford to leave.

In fact, smaller centers are lobbying Congress to overrule the proposed regulations because they fear the decreased supply of organs will force them out of business.

Laws are symbolic

The laws passed so far are essentially a symbolic gesture intended to lead to a subsequent court battle questioning whether Health and Human Services has the authority to write its rule.

The state laws, for example, allow for organ procurement organizations to continue interstate agreements for mutual benefit. States may still send livers, for example, to other states when there is a match.

Several states have considered erecting legislative walls around the state, but then reconsidered. Tennessee, for example, had a bill on a fast track for approval until a procurement organization pointed out that the existing system didn't always follow state lines. Some cities in Tennessee also serve parts of Virginia.