Emory Report

September 14, 1998

 Volume 51, No. 4

New federal legislation will hinder Emory transplant program

As part of the largest transplant program in Georgia, many Emory health care providers and administrators are concerned about organ allocation regulations from Washington.

When regulations issued last April by the Department of Health and Human Services (HHS) go into effect, they will drastically alter the way human organs are allocated for transplant. For example, the HHS expects patients in the Southeast to face an additional 86-day wait for liver transplants.

Currently organ donations from Georgians are made available to other Georgians first, then to patients in the Southeast, before being offered to those across the country. This system is believed to have an impact on the high donation rate in Georgia and the success of transplants because less time is lost in transportation of organs or transplant recipients.

The new legislation, scheduled to go into effect in October, requires organs to go to the sickest patients first, regardless of geographic distance from the donor. This has the effect of shifting organs currently used for transplants in many local or regional transplant centers across the country such as Emory to a few large national centers. Patients waiting for a transplant at a local center will have to wait longer or relocate to be closer to a national center.

The new regulation was supposed to go into effect in July but was delayed until October after opposition by the transplant community including the United Network for Organ Sharing (UNOS), which runs the nation's transplant system under a HHS contract, and most of the nation's transplant centers.

UNOS argues that the new regulation will not only cause transplant success rates to go down--and, subsequently, the number of transplants needed to increase--but also a reduction in organ donation that will increase the number of people who die waiting for a transplant.

"We have worked very hard to create a system of donation and transplantation that works," said Robert Gordon, director of the Emory Hospital liver transplant program. "Georgia transplant candidates should not be punished because a few large hospitals across the country recruit transplant candidates regardless of the rate of donation in the area and sometimes list transplant patients who at Emory would not be considered sick enough to be listed."

According to Gordon, the current system already allows organs to go to the sickest patients because patients are not listed until it is truly necessary. "Our system increases the chances of success by reaching the closest, sickest and most compatible patients," Gordon said. "Successful transplants reduce chances that the same patient will later need another transplant."

There is a chance that the effective date of this legislation could be delayed another year until November 1999. In the halting way legislation often proceeds, the House Appropriations Committee included language in the Labor/HHS Appropriations bill calling for a moratorium on the HHS Final Rule titled "Organ Procurement and Transplantation Network." But some members of Congress are working to remove this language from the bill. If that happens the rules will go into effect in about two months.

Many in the Emory community have begun a letter-writing campaign to Congress through the office of Steve Moye, associate vice president for government and community affairs. "Even though we have had some success, it still is going to be an uphill battle," Moye said. For more information on the campaign, call the Center for Transplantation at 404-712-4444.

--Diana Lewis

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