The number of transplants has risen steadily in recent years. Last year, nearly 21,000 Americans received a transplanted kidney, liver, heart, lung or other organ. But demand outruns supply. About 63,000 Americans are waiting for a suitable organ, and 4,000 a year die for lack of one, recent estimates show.
The regional distribution networks mean that healthier people in some locations sometimes receive transplants while critically ill people die waiting in other areas, critics say. Questions also have been raised about whether prominent people sometimes receive organs that should have gone to someone who is sicker or has been waiting longer.
But efforts to improve the system of procuring and transplanting organs have proven controversial.
The Department of Health and Human Services tried to solve that problem with a 1998 regulation aimed at ensuring that "allocation of scarce organs will be based on common medical criteria, not accidents of geography."
But the rule aroused fears about reduced access to organs for low-income and minority patients, fewer donations and higher costs. Congress suspended the regulation, asking the Institute of Medicine to study its possible ramifications.
Yesterday's report, based on an analysis of data for 68,000 patients on waiting lists for livers from 1995 to 1999, responds to a number of those concerns.
It finds no evidence that the 1998 regulation would reduce access to organs for minorities, people in remote areas, or those with low incomes. Neither does it conclude that distributing organs across a wider geographic area would be likely to drive down donations.
But it does find that increasing the geographical area for organ distribution may result in a more expensive system, because of the higher transportation costs associated with transplants for sicker patients. The match must be made within a critical amount of time, said Penhoet: "It has to be quickly."
Health and Human Services Secretary Donna E. Shalala yesterday called the finding a strong validation of her department's proposed reforms. It is not clear what will happen next.