Under the present rationing system, kidneys go to those patients who have been in line longest. To get more years lived per transplant, kidneys would go to the youngest patients under the proposed rationing scheme.
“We’re trying to best utilize the gift of the donated organ,” said Kenneth Andreoni, an associate professor of surgery at Ohio State University who chairs the committee that is reviewing the system for the United Network for Organ Sharing (UNOS), a Richmond-based private nonprofit group contracted by the federal government to coordinate organ allocation. “It’s an effort to get the most out of a scarce resource.”
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“It’s a big shift,” said Arthur C. Caplan, a University of Pennsylvania bioethicist. “For a long time, the whole program has been oriented toward waiting-list time. This is moving it away from a save-the-sickest strategy to trying to get a greater yield in terms of years of life saved.”
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The problem is that, in some cases, elderly recipients get organs from much younger donors whose kidneys could have provided far more years of healthy life to younger, heathier patients. Younger patients can receive older or less-healthy organs that wear out more quickly, forcing them back onto the transplant list in a few years.
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But others worry that the changes could reduce the overall number of organs available for transplants or inadvertently further shift the matches between organs and recipients by affecting living donors, who are not regulated by UNOS. Some relatives who would have donated a kidney to a young patient might now decide not to, for example, putting pressure on other relatives to donate kidneys to older family members.
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Others questioned the formula that would be used to match patients and organs. Because the system would be more complicated, it could backfire by creating suspicions of cheating, eroding confidence and reducing organ donations.
On the topic of organ transplants, Arizona dropped Medicaid coverage for some organ transplants in December. Critics charge the state’s choice of where to make the cuts was flawed. On the other hand,
Arizona’s critics are hamstrung by not being able to cite specific cost-effectiveness data to support the value of transplants. There are several reasons for this numbers gap, transplant experts say. Organ recipients aren’t chosen randomly but are selected by UNOS based on criteria such as who is closest to death or who will benefit most. That means there are no randomized, controlled trials—the gold standard for medical research—to determine whether transplant recipients do better than patients who stay on the waiting list. Also, researchers haven’t focused on cost because the limiting factor generally is available organs, not money.
Critics have said the state should find other ways to cut government spending and restore the funds to its Medicaid budget.