I would like to respond to the commentary by John Fung, M.D., chief of the Division of Transplant Surgery at Thomas E. Starzl Transplantation Institute at the University of Pittsburgh ("Survival of the sickest," Aug. 17, p. 29). He argued that organ allocation should be based on medical need, not location.
Obviously, in this debate Fung is as biased as I am. Several issues probably ought to be noted. With the rise of regional transplant centers, the original centers, such as the University of Pittsburgh, have lost considerable transplant volume. I would suggest that:
This is not only a patient-care issue but an economic argument on their behalf.
Many of the regional centers have survival rates equal to or surpassing those of the larger centers.
I am not sure why areas of the country that seem to do a better job in organ retrieval shouldn't benefit.
If the HHS rules go into effect, clearly many individuals we now serve will simply be unable to afford the cost of transportation and lodging in a distant city.
The greatest tragedy is that these rules will not change the number of people who die awaiting transplantation. They will simply change those people's address.
Stanley Hupfeld
President, chief executive officer
Integris Health
Oklahoma City
