In justifying the new rule, HHS notes that waiting times under the current system vary, sometimes widely, from one part of the country to another. The department argues that patients everywhere should have an equal chance at an organ under uniform medical criteria. HHS draws no distinctions by age or cause of disease. The HHS rule has prompted loud objections. At the local level, relations between the organ procurers who get the families to sign on the dotted line and the transplanters are tight, and the centers take a proprietary view of their acquisitions.
Sharing is often low on their list of priorities.
In testimony this year, an HHS official told Congress with horror that sometimes, even when another hospital has a perfect match, a center will give up an organ only upon a promise of future repayment in kind. 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.