Transplant centers are divided into 55 regions called organ procurement organ-izations, or OPOs. Since long transportation time could damage a donor heart, when a heart becomes available, UNOS looks to place that organ within the same OPO so it may be transplanted more quickly. Some regions have only one hospital that performs heart transplants, while others distribute organs among as many as nine centers. The study found most OPOs included two or three transplant hospitals.
"Transplant centers are under pressure to get their own patients transplanted. If the patient is on the fence between priority levels, the tendency is to push the patient over the fence to get the transplant to happen," says senior author Peter Ubel, M.D., associate professor of internal medicine at U-M Medical School and director of the U-M Health System's Program for Improving Health Care Decisions.
Using standard tests to measure competition and market share, the researchers examined patient waiting lists from all 55 OPOs from 1995 to 2000. These are the same techniques employed by the Justice Department and Federal Trade Commission in antitrust proceedings.
The researchers found that before the 1999 UNOS rule change, the more inter-hospital competition that existed within an OPO, the more likely patients were to be listed in the sickest category.
In 1999, UNOS tightened the listing rules, to divide patients into three status levels, with the highest priority reserved for patients expected to live only one month. Doctors are required to recertify their patients on this list every seven to 14 days.
After this rule change, the researchers found, the more competitive transplants centers did not have higher numbers of patients listed in either of the two highest priority levels. The researchers theorize that the new rules create a tougher threshold, making it difficult to exaggerate. Furthe
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Contact: Nicole Fawcett or Kara Gavin
kegavin@umich.edu
734-764-2220
University of Michigan Health System
9-Mar-2004