The OPTN and HHS are still negotiating, and as this is written it seems unlikely that the new rule will take effect on schedule. Proponents of localism note that transplants require a lot of follow-up, and they argue that patients do better if the operation takes place near home. They also believe that people are more likely to donate organs if they know their gift will be used locally. Another argument, hinted at but rarely stated explicitly, hinges on the fact that procuring organs requires confronting a family at its moment of maximum anguish. Medical personnel are more likely to steel themselves for this task if the organs they obtain will be transplanted by surgeons they know into their own patients.
More mercenary considerations are also at stake.
If priority is given to local use, then the industry will be characterized by a multitude of local programs, each performing a limited number of transplants. It will be difficult for national centers to develop because such entities cannot be supported by donations in a single city. Sixty percent of the people on the waiting list for the University of Pittsburgh's liver transplant program are from outside the area, for example, even as the number of procedures performed there has declined. The local centers fear that HHS wants to move toward a system of major national transplant facilities. The participants in this debate agree on a few points.