Report calls for wider sharing of organs, says system 'basically fair'

July 20, 1999
Web posted at: 4:02 p.m. EDT (2002 GMT)

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WASHINGTON (CNN) -- The nation's organ transplant allocation system does not need an overhaul but does need some tweaking including more government oversight and broadening of the regions where organs are first used, according to a report by the Institute of Medicine.

An estimated 4,000 people die each year waiting for organs. Each day about 62,000 people are waiting for an organ.

Currently when an organ becomes available, it is given to the sickest person in the region where the donor died. So it is conceivable that someone can receive an organ in one region while a sicker person is waiting in another region. This discrepancy prompted Health and Human Services Secretary Donna Shalala to call for a change. She requested a system where the sickest person in the country is first to get an organ when it becomes available, regardless of where the organ originated.

After Shalala's call for a change, Congress commissioned the Institute of Medicine to make a thorough review of the way livers are allocated.

The report looked at access, donation, waiting times, survival rates and costs. It said overall the system is fair but recommended a few changes.

The current system divides the country into 65 regions. The committee recommended broadening the regions.

Critics of a national allocation system say it will drive small transplant centers out of business and people will be less likely to donate organs if they will not be used locally. The IOM committee found no evidence that broader sharing will lead to fewer small centers or fewer donations.

Because organ availability differs between regions, some areas of the country wait much longer than others. The IOM committee said waiting times are a poor measure of the fairness or effectiveness of organ allocations because the patients who waited longest were often the healthiest and least in need of an urgent transplant.

The committee recommended discontinuing use of waiting times as a criterion for allocation for patients who are not the sickest.

The committee recommended more government oversight of the system, which is run by the United Network for Organ Sharing.

The major problem is availability of organs. One doctor said that when he asks people to donate their loved ones' organs, half say no. If more organs were available, fewer people would be fighting over the ones that are donated.

CNN Medical Correspondent Eileen O'Connor contributed to this report