By Caroline Song
In the article “Too Risky to Transplant: Patients denied transplants as donor organs are discarded,” the author writes about a growing concern in the transplant committee about the oversight of the Centers for Medicare & Medicaid Services, or CMS. The goal of CMS is to overview the majority of organ transplants within the US to improve outcomes. CMS has the power to shut down or fine centers that have low survival rates. As such, centers are beginning to restrict the number of procedures performed and screen for higher quality organs. An organ that poses only an 80% chance of survival one year post-op may be turned down. This increasing trend indicates that centers are becoming concerned about long-term survival, and while this may seem like a commendable thing to do, organs, albeit risker ones, are being turned away and contributing to the higher number of deaths occurring on waiting lists.
It seems as though CMS sanctions are indirectly causing a decrease in the number of people transplanted by forcing hospitals to be concerned about their survival rates after transplantation. Interestingly, deaths that occur on a center’s waiting list do not penalize the center. The question seems to remain as to whether patients should give consent to accepting riskier organs. It would, on one hand, decrease the number of people on the waiting list, but it would also give very sick people lower quality organs. For someone who is already dying, an organ with a 50% chance of survival seems much better then his or her assured 0%, but can we justifiably transplant more patients while the overall survival rate drops?
It should be taken into consideration that according to this article about 4,000 organs were discarded in 2012, while 6,476 individuals died on the waiting list. However, of those 4,000 organs some were not suitable for transplant, unmatched, or too far away to transplant in those they did match. Not all were simply thrown away for having a low indicated survival rate. The article also does not mention the factors that come into determining an organs risk such as a preexisting illness or age, which should also be considered. While it does seem that CMS may be contributing somewhat to the decreased number of people transplanted, there has to be something said for the need to guard against risky organs. An increase in the number of transplanted individuals, but a decrease in survival rates does not seem to bode well. It begs the question of ‘who do we deem risky enough to receive a risky organ?’ Perhaps, a decrease in the stringency of CMS regulation is in order, but not without heavy caution.
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