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Transplant Fight Takes A Turn

The dicey politics of organ transplant policy have persuaded a private group to opt out of the competition to run the nation's transplant system, leaving just one choice the current contractor.

The decision by Rand Corp. means the Department of Health and Human Services will have to continue its contentious relationship with the United Network for Organ Sharing, assuming no other bidders come forth.

Rand, a Santa Monica, Calif.-based research powerhouse, said it was too perilous to dive into a transplant fight that has been raging for more than a year and a half in Congress and across the country between HHS and many transplant surgeons.

"In the current environment, it would be difficult for any new contractor to avoid being perceived as a new combatant in an ongoing power struggle," said the letter from Rand's team sent Monday to HHS and nearly 100 other interested parties.

The contractor is responsible for developing and maintaining the computer system to match donated organs with patients waiting for them. It also develops rules that determine which patients advance to the top of the list.

The Richmond, Va.-based United Network for Organ Sharing has run the transplant system under an HHS contract since 1986, when the national system was created. It is now operating under a one-year contract extension.

The network is in the middle of a bitter high-profile fight with HHS over who has the authority to set transplant policy and what the policy should be.

HHS wants to break down the geographic lines that govern the current system, where most organs are offered within defined local and then regional areas, even if sicker patients are waiting just outside the boundaries.

The network argues the current system ensures a supply of organs for transplant centers on the country and says it encourages organ donation because families know the organs will stay within their communities.

Both sides believe they have the right to set the rules, and Congress has stepped into the middle of the fight. It put on hold HHS regulations that directed more organs to the sickest patients.

Congress also is working to rewrite the National Organ Transplant Act, which governs transplant policy. A bill passed by the House Commerce Committee would strip HHS of its authority over policy beyond administrative matters. That bill would also make it virtually impossible for HHS to give the contract to anyone other than the current contractor, UNOS.

HHS and its allies had hoped that Rand's interest in running the system would put pressure on UNOS to work more closely with HHS. It also gave the department the power to give the contract to a group much friendlier to the HHS position.

Rand said it hoped to continue working on transplant policy, including organ donation rates, quality and availability of transplant data and public trust in the system. Researchers said they also hoped to help address the fundamental problem "the lack of natinal consensus on the basic principals and structure for transplantation policy making."

But the delays in implementing the HHS rule, the contentious debate in Congress and HHS' delay in issuing a formal request for contract proposals persuaded Rand to pull out, the group said in its letter.

Even if it were chosen, the delays would not give Rand enough time to implement the complex computer system that does the matching of organs with recipients. Rand lamented the tension surrounding transplant policy would make it very difficult to operate the system.

HHS had no comment, but its allies said they were disappointed.

"The current system really is held captive by the current contract holder," said Charlie Fiske, director of the National Transplant Action Committee, a patient group. "Competition is a good thing in this particular area."