Organ allocation rules put geography ahead of need

Congress blocks DHHS order for new strategy

The Department of Health and Human Services (DHHS) recently released a report showing wide disparities in the length of time patients wait for organ transplants in different geographic areas of the United States. Some adjustments to organ allocation policies have been made, but fundamental improvements still are needed to ensure fair treatment.

Progress toward improvements was impeded in mid-March when Congress blocked an order from DHHS Secretary Donna E. Shalala to devise a new allocation strategy. Transplant centers had lobbied against any change, fearing that new rules may reduce their supply of organs.

Because of present allocation rules that put geography ahead of medical need, a patient who urgently needs an organ may be unable to obtain it, even when it becomes available in the neighboring city or state. For the largest category of patients, waiting times range from 46 days in Iowa to 721 days in western Pennsylvania. In addition, the median waiting time for liver transplant patients with similar medical status is 439 days in the Baltimore area, compared with 147 days in nearby Washington, DC. For patients with blood type O, representing about 47% of all liver transplant patients, the median waiting time is 511 days in New York City and 56 days in bordering northern New Jersey. Iowa has the shortest waiting time among all 66 organ procurement areas — 46 days. Compare that with neighboring Nebraska at 596 days.

Report highlights need for policy improvement

"This report contains some of the strongest evidence yet that our nation’s organ transplantation system needs improvement," Shalala commented. "Organs donated for transplantation should go to patients on the basis of medical criteria, not geography." New policies that were set to take effect on Oct. 21 would help assure that organs go to patients with the greatest medical need, in accordance with sound medical judgment and effective use of the organs. The current allocation rules require organs to be used in the local area where they have been procured, a primary cause of the disparity in waiting times for organs in different parts of the nation.

Significant differences also exist in organ recovery activity, with some procurement organizations reporting significantly higher rates than others. The DHHS took action last year to require hospitals to report virtually all deaths to their local organ procurement organizations, thus providing more opportunity for organizations to contact the families of potential donors and increase organ donation nationwide.

The 2,400-page report was produced by the United Network for Organ Sharing (UNOS), a private, nonprofit organization based in Richmond, VA, that distributes donated organs. An executive summary can be accessed from UNOS’s Web site, The report can be ordered from UNOS at (804) 330-8541.