~~~ thanks Ruby. we met this lovely woman, then pregnant at the IOM last Summer. she wrote some very favorable, balanced articles on our issue. Ilena ~~~

FYI Ilena, from Ruby

Study Shows Wide Disparities for Heart and Liver Transplants

By SHERYL GAY STOLBERG

(October 14) The Clinton Administration released a study on Wednesday showing startling disparities in the success rates of more than 100 hospitals that treat heart and liver transplant patients.

By SHERYL GAY STOLBERG

WASHINGTON -- As Congress considers two measures that would affect the future of the nation's organ transplant system, the Clinton Administration released a study on Wednesday showing startling disparities in the success rates of more than 100 hospitals that treat heart and liver transplant patients.

The study, by an epidemiologist at the Department of Health and Human Services, looked at what percentage of patients received hearts and livers and what percentage were still alive and what percentage had died, regardless of whether they had received new organs. It did not explain the reason for the variations from hospital to hospital.

It found, for example, that at University of Kansas Medical Center in Kansas City, 89 percent of patients who signed up for a liver received one within a year, and fewer than 8 percent of the patients on the list had died. But at the University of Maryland in Baltimore, just 21 percent had received a liver, and 21 percent had died.

The study found that over all, in both liver and heart transplants, about two-thirds of the deaths occurred while patients were waiting for organs. But it also found that performing transplants quickly after a patient was listed did not necessarily lead to better survival rates.

"The striking finding is that there is a very wide variation in the rates of transplantation among the various hospitals," said Dr. Henry Krakauer, the author of the study. "So the question arises: Why is this happening?"

That is a question the study does not answer. And while the analysis accounted for the severity of a patient's illness, it did not account for other factors that might influence a transplant center's performance, like whether a patient received pre- and post-operative care at other hospitals, or whether a small hospital's ranking might be skewed by the death of just one or two people.

The study, the first hospital-by-hospital examination of what happens to all patients who put their names on the transplant list, was based on data collected by the United Network for Organ Sharing, the nonprofit organization that contracts with the health and human services agency to run the transplant system. A spokesman for the network, Joel Newman, described the study as "an interesting report," but questioned its usefulness.

The study, which appears to buttress the Clinton Administration's argument that the organ allocation system is unfair, comes as it is facing two battles in Congress over how the transplant system should be run.

In February 1998, Donna E. Shalala, the Secretary of Health and Human Services, released data showing that the time patients spent waiting on transplant lists varied greatly by region and ordered the network to change its policies so that scarce organs could be shared more broadly across state and city lines.

But the network complained so vigorously that Congress put a moratorium on the Government's proposed rule. That moratorium is set to expire next Thursday; Congress is considering whether to extend it for another year.

Dr. Shalala has said she will put her rule into effect if the moratorium is not extended.

At the same time, the National Organ Transplant Act, the law that declares organs a national resource and sets out broad guidelines for how they should be allocated, is up for renewal. The House Commerce Committee today sent to the full House a bill that would greatly reduce Dr. Shalala's authority over the organ sharing network. The Administration opposes the bill.