Organ-Transplant Rules Revised, but Critics Persist

WASHINGTON — Hoping for peace in a bitter fight over organ transplant policy, the Clinton administration announced changes Monday in a regulation aimed at directing scarce organs to the nation’s sickest patients.

But even with the changes, the government retains ultimate control over how organs are distributed, and transplant officials said the revisions are not enough to end the fierce battle over the allocation of donated livers, hearts, kidneys, lungs and pancreases.

The changes, released by the Department of Health and Human Services, reflect a host of concerns voiced by transplant surgeons and centers over the last year and a half. They make clear, for instance, that organs should not be wasted by shipping them coast to coast or futilely transplanting them into dying patients.

But the regulation still gives the HHS secretary ultimate power to approve or veto any allocation plan and would still require an overhaul of the current system.

Transplant officials said they will continue to fight the regulation, despite some improvements.

“The secretary continues to insist on having the final word on decisions relating to the allocation of organs,” said a statement from Dr. Ronald W. Busuttil, president of the American Society of Transplant Surgeons. “These are medical decisions. . . . The secretary should not be making medical decisions.”

Organs are now allocated within arbitrary geographic lines, offering donated organs to patients within local communities, even if there are sicker patients elsewhere. The system helps ensure a reliable supply of organs, particularly livers, for transplant programs across the country, and programs across the country have rallied to protect it.

The regulation requires that organs be allocated according to medical need, with the sickest patients getting first chance.

Transplant officials objected to the details of the proposal and to the secretary’s prerogative to control the system.

Specifically, they feared it would mean one national list, with organs needlessly flying across the country. So Monday’s revision makes it clear that the distribution should be “over as broad a geographic area as feasible,” and says all policies should be written “in accordance with sound medical judgment.”