Donor system needs change

One of the most controversial and ethical issues in medicine today is the organ allocation system.

Many pediatric transplant experts and parents feel the current system is unfair to children and doubt reforms - when and if they come - will improve the situation.

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Suzanne Johnson

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Currently, the organ allocation system does not differentiate between adults and children. All patients are ranked according to the severity of their illness.

In addition, patients are listed geographically. The United States is divided into 63 local areas and 11 regions. When an organ becomes available, it is first offered to patients locally. If there are no recipients, it is offered regionally then nationally.

The Clinton administration is seeking to change this geographically based allocation by creating a national list that will rank patients solely on the severity of their illness. Patients have died because others lower in on the priority list lived in the right place.

Critics say if organs are always offered to the sickest patients first, doctors will inevitably perform transplants on patients who will surely die or who will require additional transplants. Children represent the best possible long-term survival rate, they say.

"Justice would say that the sickest person gets the first organ," UCLA Medical Center Dr. Sue McDiarmid said in a recent Los Angeles Times article. "Utility would say put the organ where it will do the most good for the longest period of time."

The administration has told the United Network for Organ Sharing to develop uniform criteria for deciding who should be placed on the list and to develop a system for ranking equally sick patients to ensure they receive similar status.

Celebrity status or money should not be determining factors in how quickly one receives an organ, as appears to be the case with Mickey Mantel and Larry Hagman.

"Pediatric patients can't live long enough on a waiting list to get high enough to compete with adults, and nothing has really been done to address that," Dr. Paul Colombani, chief of pediatric surgery at John Hopkins Medical School, said.

Who will determine which life should be preserved? Is a child with infinite potential more valuable than a loving mother or a successful businessman?

Many view children as our best investments in the future, and are works in progress who should receive every possible benefit to help them grow and flourish.

The fact that children are competing with adults for organs angers many. Most often, children are the innocent victims of their illness. Adults, on the other hand, have often participated in the destruction of their organs by using alcohol or drugs.

The organ allocation system needs to be reformed to treat children as a separate entity. Those who are repeatedly up for transplants because of their own destructive behavior should be eliminated from the list.

Opponents argue that judgment has no place in medical decisions such as these. All that matters is the illness, not the cause of it, they say.

It makes no sense however, to offer an organ to one who will abuse such a privilege over one who will not.

Last year, according to the United Network for Organ Sharing, 3,565 children were awaiting transplants and 311, 8.7 percent, died while waiting.

That same year, 76,526 adults were in need of transplants and 4,278, 5.6 percent, died before organs became available.

Suzanne Johnson is a journalism major at CSULB.