Archive for Tuesday, September 7, 1999


September 7, 1999


A recent study says proposed changes in the way donated organs are allocated will cut down on the number of organ donors.

The U.S. Department of Health and Human Services administration is pushing ahead with efforts to broaden boundaries for organ allocations, but a Kansas University Medical Center surgeon maintains the current system that keeps organs closer to home is not faulty.

Dr. Jameson Forster, head of the liver transplant program at KUMC, said he's afraid that if a nationwide system is established, Kansas patients would receive fewer livers, kidneys and other organs. He is joined in his opposition by James Shanteau, a Kansas State University psychology professor who believes changes in the system would alienate potential donors.

"What we try to do is to focus not on the medical issues -- we're not medical doctors here -- but rather on the psychological issues involved in making that decision to donate," Shanteau said in a release from Kansas State News Services. "Without people making the decision to donate, obviously no transplants are going to occur."

Regional centers that allocate the organs give local patients the first priority. KUMC receives its organs through the Midwest Transplant Network of Kansas City, Kan. The organization serves Kansas and Missouri transplants centers.

Obstacles to donation

K-State professors have been conducting research on organ donation decisions for the past 12 years. The university is considered a leader in information about the donation process and has the largest library of materials on donation in the world, Shanteau said.

Among the barriers affecting donors, according to Shanteau:

  • Quasi-religious beliefs: While every major religion has taken a position that organ donation doesn't violate religious doctrines, Shanteau said some people believe it does.
  • Misunderstanding of the system: Donors must do more than sign the back of their driver's licenses to give permission to become a donor. While it's not an irrelevant step, Shanteau said it's more important to notify close relatives.
  • Location of the organ recipient: Shanteau's research shows there's a greater willingness to donate if people can be assured the organ will stay in their community or state.

"If there is no such assurance, then I think one of the concerns people will have is who will benefit from the organ donation," he said. "A growing fear is that the new nationwide organ donation policy might actually cause a decline in the rates of donation."

Forster said the allocation process used by the United Network for Organ Sharing (UNOS) relies on several factors, including blood type, health of the donor and recipient, and the donor's location.

Forster fears that allocating organs without regard to ZIP codes could spur larger transplant centers on the East Coast and West Coast to place people on the organ list sooner to heighten the sense of urgency.

"This wipes out any ability for organs from Midwesterners to go to Midwesterners," he said. "We'll have lots of organs going to other places. We don't put people on the list until they absolutely need a liver, even though by the criteria they may have been eligible for the list.

"There's something like feeding the fire. How do you have a big program? You have to have a big list; you have to keep generating names for the list," Forster said.

Since January 1994, KUMC surgeons have transplanted 180 livers, 172 kidneys and one pancreas. They have performed 10 pancreas and kidney combination transplants since a new program started last year.

'Good science'

Critics' fears are unfounded, said Jon Nelson, director of the office of special programs for HHS. Nelson said 33 percent to 35 percent of all donated organs already go to recipients in other states, and some organs, especially hearts, stay within regions because of quick expiration rates.

"This process ought to be driven by good science to make sure the person that needs the organ the most is able to benefit," he said. "I absolutely dispute any notions that people in general think that donations will drop if the organs go outside their local community. All the research I've seen shows that Americans doubt that."

HHS Secretary Donna Shalala released a statement in July supporting recommendations outlined by the Institute of Medicine. As an arm of the National Academy of Science, the institute responds to congressional inquiries about proposed policy changes regarding medicine.

"The panel's leading recommendation is for broader sharing of organs. This has been a primary goal for HHS, and is at the heart of the regulations we have issued," Shalala said in the statement. "The panel finds that broader sharing will increase transplantation rates for patients with greatest medical need, and in that way more lives can be saved."

The issue of changes in the system is not new, Forster said. About half of UNOS' membership is transplant surgeons, and various committees constantly review practices and policies. The proposed new policy regarding allocation of donor organs is one of the more complicated and drawn out issues UNOS has dealt with and became a front-burner issue in February 1998 when Shalala proposed the restructuring.

"It's a very complicated issue; it's not a black and white issue," Forster said.

-- Chris Koger's phone message number is 832-7126. His e-mail address is

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