WASHINGTON – Patients in need of organ transplants face a longer wait in Maryland than in many parts of the nation, including nearby mid-Atlantic states, according to a recent report for the Department of Health and Human Services.
Liver patients in greatest need of a transplant, for example, waited 16 days for a suitable organ in Maryland compared to a national average of four days and a regional average of five days.
The wait for a kidney transplant averaged 1,041 days in Maryland compared to a regional average of 784 days and a national average of 645 days for patients deemed most likely to have successful transplants. The report for HHS covered transplants between 1993 and 1996.
Maryland’s relatively long waiting times are attributed to a variety of factors, including a large African-American population, a relatively small population from which to harvest organs and the success of organ transplant centers here, which draws people in need of organs.
“When you do a good job with organ transplants it’s almost counterproductive,” said Dr. Andrew Klein, director of the Johns Hopkins Comprehensive Transplant Center. “More people want to come here, but we primarily draw organs from within the region.”
One way to address Maryland’s shortage of available organs would be to import useable organs from other states where the need is not so great — but that plan has sparked a heated debate about the national organ allocation system.
Opponents argue that organs may not be as viable if they are shipped across country to the person with the greatest need, instead of trying to match organs to the neediest patient in the area where they were harvested, as is currently done.
But supporters of the change said it would go a long way toward equalizing waiting times for patients across the country.
“Let’s do a better job of sharing,” said Charlotte Mehuron, spokeswoman for HHS’ Health Resources and Services Administration.
The need to share is particularly acute in Maryland.
Because Maryland hosts two of the nation’s premiere transplant centers — Hopkins and the University of Maryland Medical System’s transplant program — a large number of out-of- state patients put their names on waiting lists here.
The Maryland Transplant Resource Center said that 30 percent of the 2,239 patients on its waiting list last month lived outside its local service area, which includes all of the state but Montgomery, Prince George’s and Charles counties.
Resource center CEO Marion Borowiecki said that Hopkins and the University of Maryland draw patients from elsewhere because they perform all types of transplants, unlike some centers that specialize in particular organs. Borowiecki also said that Hopkins’ pioneering work — including the use of live kidney donors and the transplantation of partial kidneys — attracts patients along with the national acclaim.
“It’s basically a case of supply and demand,” Borowiecki said.
He emphasized that the actual demand for organs in Maryland outnumbers the potential supply by almost 3:1. Borowiecki said that while the region covered by his center has only 1.25 percent of the potential donors in the nation, the center’s waiting list accounts for 3.65 percent of the national total.
Another factor fueling Maryland’s imbalance in the organ supply and demand is the large number of blacks in the state awaiting kidney transplants. The National Kidney Foundation’s web site said that while African Americans make up 12 percent of the U.S. population, they account for 30 percent of patients with end- stage kidney disease.
A spokesman for the United Network for Organ Sharing, the national umbrella group that oversees organ transplant distribution and policy, said that ethnic groups tend to donate at a rate representative of their share of the overall population. But Joel Newman said that for blacks, the demand for kidneys simply outstrips the supply.
Of the 1,325 patients waiting for kidneys in Maryland during the period covered by the report, 581 were African Americans. Only 15 blacks donated kidneys in Maryland’s organ recovery area in 1998, resulting in 18 local kidney transplants for African Americans last year.
In an effort to equalize waiting times, HHS in April ordered the United Network for Organ Sharing (UNOS) to relax geographic constraints on organ sharing and put greater emphasis on patients’ medical conditions.
Congress put the brakes on that proposal in October, after UNOS and some doctors raised fears that the wider sharing network envisioned by HHS would lead to greater waste.
UNOS spokesman Bob Spieldenner said some organs have limited viability outside donor bodies and might be wasted if they are shipped too far. He also said the sickest patients are not always the best candidates for a successful transplant.
And Spieldenner said that shipping organs to nationally recognized transplant centers with the longest patient waiting lists might put smaller centers out of business and deprive their patients access to transplants.
Some doctors argue that certain organs cannot travel very far. A heart, for instance, must be transplanted within four to six hours.
But staff at Maryland’s transplant centers are quick to point out that that only holds true for certain organs such as hearts and lungs. They say that kidneys, for example, could be easily shipped across the country to areas where the waiting lists are longest and patients are most in need.
Kidneys are the most sought-after organ in Maryland, accounting for 68 percent of the state’s waiting list.
The two sides cannot even agree on how long various organs are viable for transplant. Mehuron said that HHS believes kidneys are viable for as long as 72 hours and that livers are good for 24 hours. UNOS argues that kidneys should not travel for more than 48 hours and that livers are viable for transplant for only 12 hours, said Spieldenner.
The one thing that both sides agree on is that nothing will improve unless more people agree to donate organs and share that wish with their families.
There has been some improvement. Borowiecki said that the number of organs harvested in the state has gone up since 1996, the last year covered in the HHS study, increasing 30 percent from 1997 to 1998 alone.
In 1997, state hospitals harvested organs from 53 donors, which resulted in 112 transplant operations. That number grew to 69 donors in 1998, resulting in 226 transplants.
“Organ donation is looked at as a potentially positive outcome to something that’s been so devastating,” said Robert Dice, trauma coordinator at Johns Hopkins Bayview Medical Center.