BY TIM BONFIELD
The Cincinnati Enquirer
Most people in Ohio would prefer that organs donated by state residents go to Ohio transplant patients, but most also support sending organs out of state if a patient there has spent more time on a waiting list or has a better chance of survival.
Results from a statewide survey sponsored by the Ohio Solid Organ Transplantation Consortium were released Wednesday, the same day a federal court agreed to delay a nationwide change in organ distribution policy that was to take effect today.
Ohio experts who have been critical of the new policy say the survey shows that the public has mixed feelings about a complicated issue, a finding they say supports no more than minor changes in America's current organ-sharing system.
POLL HIGHLIGHTS
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A telephone survey of 846 Ohio residents gauged public attitudes about how organs should be distributed for transplants. The survey was conducted in May. Margin of error was plus or minus 3.4 percentage points.*
91.8 percent of respondents agreed there is a shortage of organs for use in transplantation.
55 percent would be "very willing" and 23 percent would be "somewhat willing" to donate their own organs when they die.
If two patients, one from Ohio, one not, were equally sick and had spent the same amount of time on the waiting list, 78 percent said organs donated in Ohio should go to the Ohio patient.
However, if the out-of-town patient had spent more time on a waiting list, 79 percent said the Ohio-donated organ should go out-of-state.
Meanwhile, 55 percent said organs should go first to patients with the greatest chance of survival; 38 percent said the sickest patients should get them first even if that means lower success rates for transplants.
53 percent said it is reasonable to expect patients and families to travel more than 1,000 miles to get a transplant, while 30 percent said people should travel less than 250 miles.
*Margin of error means that the survey estimates are projected to be accurate to within 3.4 percentage points if all adult Ohioans were interviewed.
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But experts at the University of Pittsburgh -- who have been pushing for the new policy -- say the survey supports their view that geographic differences in waiting times for organ transplants are unacceptable.
Either way, the survey failed to settle the continuing war of words over how best to distribute the nation's chronically short supply of organs for transplant.
"People are not going to tolerate a tenfold difference in waiting times just because of where they live. There has to be a better system than the one we have now," said Dr. John Fung, chief of transplant surgery at the University of Pittsburgh Medical Center.
But Dr. Douglas Hanto, director of adult liver transplants for the Health Alliance of Greater Cincinnati, said: "The Pittsburgh model is not what people want."
"(Dr. Fung and other supporters) want the sickest patients to get the organs first, even if they have less chance of survival," Dr. Hanto said. "We think the public still supports the existing system, which strives to provide the maximum benefit for the maximum number of Americans."
An independent group called the United Network for Organ Sharing (UNOS) decides how donated organs are distributed. The system gives local transplant centers the first opportunity to use locally donated organs. If the local waiting list includes no suitable matches, the organ is offered to a wider region, then to anybody on a nationwide basis.
Critics say the result is that local patients can get an organ even if they are less sick or have spent less time on a waiting list than other, out-of-state patients. They have proposed, and won, changes in regulations from the U.S. Department of Health and Human Services that would require UNOS to develop a new system that eliminates the waiting list disparities.
Those regulations were expected to take effect July 1, but were delayed until Oct. 1. They were delayed again by a temporary injunction issued by the U.S. District Court in Baton Rouge, La., where the court is hearing a dispute between the federal rules and a state law that gives preference to Louisiana patients for organs donated there.
The Ohio survey, conducted in May, uncovered complex attitudes about this complex issue.
When all conditions are equal, 78 percent prefer that locally donated organs go first to local patients. But 79 percent support sending organs to the person waiting the longest, no matter where they live.
Those surveyed also placed few limits on how far they expect people to go to get a transplant; 53 percent said it would be "reasonable" to travel more than 1,000 miles while 30 percent said 250 miles or less would be reasonable.
To Dr. Hanto, the most telling response in the survey was that 55 percent want organs to go to the person with the best chance of survival vs. 38 percent who say organs should go to the sickest patient.
This response reflects support for the current system, Dr. Hanto said. The reality of organ transplantation is that, while waiting, some patients' health deteriorates so much that doctors are reluctant to perform a transplant. The result of switching to a "sickest first" policy would be that more patients would die sooner after transplantation, while others with a strong chance of long-term survival would no longer qualify, Dr. Hanto said.
But Dr. Fung said the new regulations specifically seek to avoid requiring doctors to do transplants in futile cases. Instead, he contends it is immoral to allow seriously ill patients to die on waiting lists while less needy patients -- people who could survive a year or two without a transplant -- are getting the organs.
"If people really believe that patient survival is the most important thing, then the 20 percent of programs in this country that are sub-optimal should be closed down," Dr. Fung said. "The only thing keeping some of those programs alive is UNOS's local-regional-national policy."
In Ohio, transplant centers and organ procurement agencies are expanding their "local" region to include Michigan and Indiana as an incremental way of reducing disparities on waiting lists, said Audrey Bohnengel, executive director of the Ohio Solid Organ Transplant Consortium.
"I think this survey shows that people in Ohio are fair and generous. If there is a demonstrated need, they are willing to share," Ms. Bohnengel said.
But she remains unconvinced that Ohioans support the deep changes in the organ distribution system that the new federal regulations would bring.
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