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Executive Summary
Pages 1-16

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From page 1... ... In an analysis of approximately 68,000 liver patient records, the committee developed several conclusions and recommendations largely specific to liver transplantation policies. Included among these is the fact that, as previously calculated, the overall "median waiting time" that patients wait for organs the issue that seems to have brought the committee to the table in the first places not a useful statistic for comparing access to or equity of the current system of liver transplantation, especially when aggregated across all categories of liver transplant patients. Read the entire page →
From page 2... ... One of the most visible and contentious issues regarding the fairness of the current system of organ procurement and transplantation is the argument that it results in great disparities in the amount of time potential liver transplant patients wait for a transplant, depending on where the patient lives. (The term "waiting time" is used throughout this report to refer to the time from registration at a transplantation center to transplant, death, or removal from the waiting list for other reasons.) Read the entire page →
From page 3... ... Concerns were expressed that its implementation would increase the cost of transplantation, force the closure of small transplant centers, adversely affect access to transplantation on the part of minorities and lowincome patients, discourage organ donation, and result in fewer lives saved. Some opponents of the rule also argued that DHHS had exceeded its statutory authority by establishing a process for reviewing Organ Procurement and Transplantation Network (OPTN) Read the entire page →
From page 4... ... Dom We site of donation to Me site of transplantation, is Me responsibility of organ procurement organizations (OPOs) Read the entire page →
From page 5... ... Because liver allocation was at the center of the debate leading to this study and there are several unique factors related to liver transplantation (e.g., the lack of medical alternatives to transplantation, such as dialysis for kidney patients) , and because of the severe time constraints placed on this project by Congress, the committee focused its attention primarily on issues related to the policies, practices, and data concerning liver procurement and transplantation. Read the entire page →
From page 6... ... . OAAs should generally be established through sharing arrangements among organ procurement organizations to avoid disrupting effective current procurement activities. Read the entire page →
From page 7... ... Appropriate Consideration of Patient Waiting Times Disparities in overall median waiting times for liver transplants have been cited as an indicator of the unfairness of the current system. However, for the reasons set forth below, the committee concluded that this is not an appropriate measure of the fairness of the system. Read the entire page →
From page 8... ... 8 0.20 0.18 _ 0.16 ct i I 0.14 ~ en 1 0.12 o >, 0.10 ._ ._ `~5 0.08 o 0.06 nn' 0.02 non 0.04 s 0.03 o . Read the entire page →
From page 9... ... EXECUTIVE SUMMARY C) � C 0.08 9 3 4 5 9 10 1 1 12 Month 1 C) Read the entire page →
From page 10... ... Because status 3 patients greatly outnumber those in other status groups, the overall median waiting time-for either an OPO or a transplant center is primarily determined by the waiting times for these patients. However, these are the patients with the least urgent need of transplantation, as well as the patients, on average, with the longest periods of time on the waiting list. Read the entire page →
From page 11... ... African American kidney patients on waiting lists are transplanted at a lower rate than white patients, but similar disparities have not been shown for liver patients. The evidence is inconclusive that the Final Rule would result in the closure of smaller transplant centers located in areas that are more accessible to the residences of prospective transplant patients. Read the entire page →
From page 12... ... The committee's analysis of data on posttransplant mortality of recent liver transplant patients revealed that patients receiving transplants at centers served by lower-volume OPOs had higher mortality rates relative to larger-volume OPOs. In addition, the 1999 IJNOS report on graft and patient survival rates showed that low-volume transplant centers had lower than expected 1-year graft survival rates. Read the entire page →
From page 13... ... Costs 13 The committee examined whether implementation of the Final Rule would increase transplantation costs because of the combined effects of sharing donated organs over a greater geographic area and using donated organs in patients who are more severely ill. Based on information obtained by the GAO about organ recovery practices from officials at six OPOs, the committee learned that costs vary considerably among transplant centers and OPOs. Read the entire page →
From page 14... ... The committee believes that the purposes of the National Organ Transplant Act would be better served if Here were enhanced oversight and governance of He system, aided by improved efforts at assessing the performance of all key components. In addition, He committee concluded ~at, although a considerable volume of data is collected, some important data elements are missing, there is often a lengthy time lag In the data Hat are available, and these data are not readily accessible to patients, He health services research community, or the general public. Read the entire page →
From page 15... ... s primary mission serving the needs of transplant patients. The establishment of the scientific review board would make a particularly important contribution toward ensuring that there is a consistent and coherent view as to how the system should operate, that the policies and practices are based on the best scientific and medical knowledge currently available, and that the interests of transplant patients are given paramount importance. Read the entire page →
From page 16... ... EVOLUTION OF THE FEDERAL SYSTEM OF ORGAN TRANSPLANTATION The current arrangement of 62 organ procurement organizations nationally evolved gradually, reflecting improvements in transplantation science, organ preservation, and other factors. Historically, the hospital in which the donor resided was responsible for locating a recipient. Read the entire page →

From page 1...

... In an analysis of approximately 68,000 liver patient records, the committee developed several conclusions and recommendations largely specific to liver transplantation policies. Included among these is the fact that, as previously calculated, the overall "median waiting time" that patients wait for organs the issue that seems to have brought the committee to the table in the first places not a useful statistic for comparing access to or equity of the current system of liver transplantation, especially when aggregated across all categories of liver transplant patients.

Executive Summary Pages 1-16

Executive Summary
Pages 1-16