Organ network reviews kidney allocation policies

A UNOS panel listens to kidney recipients, and those waiting for kidneys, as part of its discussion on how to create the fairest transplant system.

By Andis Robeznieks, AMNews staff. March 28, 2005.

As stories regarding the lengths to which desperate patients will go to get an organ continue to grab headlines, the United Network for Organ Sharing has started a top-to-bottom review of its deceased donor kidney allocation policies with the stated purpose of creating a more rational system.

Although the system strives to be fair, officials acknowledge disparities based on blood type and geography. Those are just two of the issues they must hammer out along with making more precise decisions in balancing justice -- which looks at how long a person has been on the waiting list -- and utility -- which seeks to make the best use of scarce resources.

"Everything's on the table," said UNOS Ethics Committee Chair Mark D. Fox, MD, PhD, a physician ethicist at the University of Oklahoma College of Medicine in Tulsa. "We're trying to look at every aspect of this. There are so many factors to balance."

Dr. Fox met with other physicians and UNOS officials in Chicago March 11 to hear from patients who had received kidneys and from those still on the waiting list.

The patients gave powerful and sometimes emotional testimony. UNOS Kidney Allocation Review Subcommittee Chair Mark Stegall, MD, said the patients' statements would be weighed when making any changes to the system.

He added that it was possible to absorb the emotional testimony and still come out with a rational system that balances the highly charged issues of quality versus quantity of life.

"You really care about what happens to individual patients, and we never forget why we're in this business," said Dr. Stegall, a transplant surgeon at the Mayo Clinic in Rochester, Minn. "But we know there are 60,000 stories out there, and we have to find the best way to help them. You can get passionate about that."