Organs should be made available to the sickest patients across wider geographic areas than they now are, a much-anticipated report from the Institute of Medicine (IOM) has concluded.
The report was issued July 20 by the private, nonprofit IOM at the request of Congress after the Department of Health and Human Services (HHS) published a rule last year that would require organs to be offered to the sickest patients first regardless of where they live in the United States. Implementation of the rule has been delayed until October, but the rule could undergo revisions in light of the IOM's findings.
The report, which paid particular attention to the allocation of livers, recommended that livers should be distributed over an area large enough to serve at least 9 million people. Solid organs traditionally have been offered first to patients-regardless of how urgently they need them-who live within areas served by individual organ procurement organizations, which serve from 1 million to 12 million people. The IOM determined that, despite speculation to the contrary, distributing organs across a wider geographic area would not likely cause a decrease in organ donation rates.
The United Network for Organ Sharing (UNOS), which oversees organ distribution, has strongly opposed efforts by the HHS to base allocation solely on medical urgency. However, in June UNOS approved a new way to distribute livers in the United States that broadens geographic access to livers for the sickest patients from a locally based system to a regionally based one (see Transplant News Network, July 1, 1999). The IOM's recommendation "is remarkably similar" to the new UNOS policy, UNOS president William D. Payne, MD, said in a letter to members of UNOS.
Although HHS Secretary Donna E. Shalala said that the IOM's findings provide "a good basis for moving ahead now to finalize our rule," she did not indicate whether HHS would continue to press for a nationwide distribution system.
For Your Information:
Dr. Payne's memo:
www.unos.org/newsroom/archive_newsrelease_19990720_iom.htm
You can also download IOM's report at this site.
The report can be ordered at http://books.nap.edu/catalog/9628.html.Secretary Shalala's statement:
www.hhs.gov/news/press/1999pres/990720.htmlPress release from the IOM:
www4.nationalacademies.org/news.nsf/isbn/030906578X?OpenDocumentStatement from Edward Penhoet, PhD, chairman of the IOM committee:
http://www4.nationalacademies.org/news.nsf/(ByDocID)/BF3EED7C74325495852567B4006832AA?OpenDocument
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