A Life And Death Struggle

The federal government and the surgeons and hospitals running the nation's transplant network are in a fierce fight over which patients should get the first chance at scarce organs.

Two months after the government ordered that lifesaving organs be given to the sickest first, the network is lobbying Congress and warning communities that their transplant centers could close. Federal officials, meanwhile, are flying around the country to take their case directly to surgeons.

The two sides haven't yet met, though they have a meeting scheduled in June.

The disagreement won't be resolved easily. Beyond the controversy over organ allocation, it involves questions about how much control the government should have over the private company running the transplant network.

Although the regulation issued by Health and Human Services Secretary Donna Shalala affects all organs, the sharpest controversy concerns livers.

Last year, 4,159 liver transplants were performed, but another 1,131 people died waiting for one. Under the current system, patients living closest to the donor get that liver, even if someone sicker lives elsewhere.

The government's order would change that. But with a limited supply of organs, any policy will give preference to one patient over another, meaning someone loses.

"Unless you've got God making the decisions, ultimately someone's going to think it's not fair," said Howard Nathan, executive director of Delaware Valley Transplant Program in Philadelphia.

People have staked out their positions, said Dr. Alan N. Langnas, a University of Nebraska liver surgeon who notes that transplants are prestigious and lucrative. "None of us can get past self-interest."

It was March when Shalala declared that people are dying simply because of where they live. She issued a broad regulation governing the United Network for Organ Sharing, known as UNOS, that included a mandate that UNOS devise a new allocation scheme for organs that gives priority to people in greatest medical need. It allowed for a period of public comment before it took effect.

UNOS responded with a "legislative action kit" to help transplant officials lobby Congress and the media to oppose the regulation, which they see as a government grab for control.

That infuriated federal officials, who say the network is scaring people by sketching worst-case scenarios rather than finding a satisfactory solution.

"To have UNOS do such a blanket smear campaign just has been extremely frustrating," said Dr. Claude Earl Fox, who heads the HHS section that oversees the transplant program.

Network officials counter that they have no choice but to fight the rules before they become law. "It's speak now or forever hold your peace," said Walter Graham, UNOS' executive director.

UNOS has already scored one success: Congress delayed the regulation from taking effect until Otober giving lawmakers time to consider overturning it.

The current system offers a donated liver to local hospitals first, with the sickest patients getting first chance. If there are no local matches, it is offered regionally, then nationally.

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