A national organ-sharing network is threatening sanctions that could severely curb the state's ability to obtain kidneys for local transplants -- a move that could have life-or-death consequences for scores of patients in Maryland.
Two of Maryland's most prominent hospitals -- Johns Hopkins School of Medicine and the University of Maryland Medical Center -- have been so successful in their transplant programs that they have inadvertently helped give the state the largest kidney "debt" in the nation.
Maryland's debt yesterday stood at 64, according to the Transplant Resource Center of Maryland. It was calculated as the surplus of kidneys brought here for transplants over those shipped to patients out of state.
United Network for Organ Sharing (UNOS), the nonprofit group that holds a federal contract to enforce transplant policy nationwide, has notified local medical officials that the imbalance must be cut by 50 percent by November. The next step would be to require the state to ship nearly all kidneys it obtains to other states. Kidneys collected from living donors would not be affected.
"This could severely increase the waiting times for people on the kidney waiting list, which is already pretty high, by saying that every kidney donated here will go out of your territory until you pay us back," said Joseph O'Donnell of the Transplant Resource Center of Maryland.
Dr. Andrew Klein, director of the comprehensive transplant center at Hopkins, said he would be very concerned if Maryland were singled out for sanctions.
"The guiding principal in allocating kidneys should be the best medical practice," he said. "Because these centers are successful and more patients want to be cared for here, that somehow is negatively calculated. It is not ethically justifiable."
The 1,500 patients on Maryland's list awaiting kidneys face extensive waits. On average, Caucasians wait 790 days for a kidney transplant in Maryland, compared with the national average of 553 days. African-Americans here wait 1,452 days compared with the national average of 1,082, according to the most recent figures.
After a meeting in June, UNOS notified transplant officials across the country that those with a debt higher than 10 kidneys must reduce their numbers by 50 percent by November or face sanctions.
"The organ distribution system relies on trust and the sharing of organs, and if there's anything that upsets the balance, it makes it more difficult for the system to operate," said UNOS spokesman Bob Spieldenner. "They want a good relationship, but it's a two-way relationship, not a one-way relationship."
Spieldenner said yesterday that he was unable to release debt figures for individual states.
In a recent letter to UNOS, Marion Borowicki, executive director of the Transplant Resource Center of Maryland, called the debt formula "nonsensical" and asked that the payback requirement be eliminated.
The center is heavily promoting organ donation and reports an increase in kidney collections from local donors of 30 percent since last year.
But UNOS officials say their policy stands, though a committee is reviewing Maryland's arguments.
Distinction becomes liability
The rule effectively turns Maryland's distinction as home to the country's most prominent kidney transplant centers -- UM and Hopkins -- into a liability, say local officials.
"In excess of 30 percent of the people on our waiting list aren't even residents of Maryland," Borowicki said. "We are an importer of organs from elsewhere in the country, and there are some very good reasons why we are that way."
The formula handicaps Maryland in various ways, he says.
Although Maryland represents only 1.3 percent of the U.S. population, Maryland patients make up 3.5 percent of the national waiting list.
Maryland has found that 61 percent of the organs it has offered nationally have been rejected by other states this year. As a result, the state has not been able to lower its debt.
The attraction of UM and Hopkins transplant centers figures into the formula in a way that adds to Maryland's debt.
For example, a patient from Pennsylvania might come to Baltimore for a transplant of a kidney received from Pennsylvania -- but the kidney would be charged on Maryland's record because the surgery would be performed here.
Anticipating potential problems, Maryland transplant officials wrote to UNOS this summer asking that the kidney payback requirements be eliminated.
"This debt limits the functioning of TRC and the two hospital transplant centers, tarnishes the reputation of the institutions, and carries with it the implied threat that UNOS may apply harsh sanctions at some later date which could curtail kidney transplants in Maryland," officials wrote in a July 20 letter.
As an example of the weakness of the debt formula, Maryland officials wrote about a patient from another state who underwent a transplant in Maryland. Not only had the patient been on a waiting list outside of Maryland, but the other state's program had declined the same kidney used successfully in Maryland.
Pub Date: 10/07/98