JANUARY 1984. VOL 39. NO 1 A O R N JOURNAL

Legislation

Will Human Organs be Bought and Sold?

c] “Kidney donor available. Start enjoying life,” read the classified ad in a Detroit news- paper.

Transplantation successes have opened up new questions.

0 How can we procure enough organs to meet the growing demand?

0 Will organs be bought and sold? 0 How can we ensure that organs are distrib-

uted fairly and efficiently? Who will pay for this expensive but poten- tially life-saving treatment?

Major gains in transplantation are largely due to effective immunosuppressants such as cyclo- sporin A. With these drugs, kidney transplants are 95% successful in some hospitals. The success rate of livers is 65% to 70%, and almost 80% of heart transplant patients are alive one year after surgery.

As a result, demand is outstripping the number of available organs. We’ve all heard the dramatic appeals from parents of children needing liver transplants. Some 6,700 kidney dialysis patients are awaiting organs. Estimates are that the dialysis population of about 65,000 grows by 6,000 a year, but the annual increase in kidney transplantations is only 200 to 400.

According to the Centers for Disease Control, from 12,000 to 27,000 of the people who die each year in hospitals are potential organ donors. Yet only about 15% give their organs, although public opinion is strongly in favor of transplanta- tion.

How can people be encouraged to donate? Money is one way. No state has a law against organ sale by living donors, but many people

find it objectionable. The practice might raise more social, ethical, and legal problems than it solves.

Better coordination of referrals is an alterna- tive. National legislation would further the ef- fort. Two major proposals are now before Con- gress.

A Democrat bill prescribes a larger role for the federal government, whereas a Republican mea- sure relies on private initiative. Democratic rep- resentatives Henry Waxman (Calif) and Albert Gore (Tenn) are sponsoring HR 4080, the Na- tional Organ Transplant Act. The Senate com- panion bill (S 2018) was put forth by Sen Edward Kennedy (D-Mass). Its major features are

0 a computerized national transplantation network with a national registry and 24- hour hotline increased funding for local procurement agencies, which would be part of the net- work a new National Center for Organ Transplan- tation in the US Department of Health and Human Services (HHS) to promote public awareness and examine medical, legal, and ethical issues

0 permitting HHS to pay for investigative organ transplants at several medical centers a clause outlawing organ sales.

Rep Waxman said his goal was to “remove hap- penstance as a criteria for matching a donor with a patient.”

The Reagan administration opposes larger federal involvement, proposing instead that pri- vate networks be strengthened. Republican Sen Orrin Hatch of Utah has offered S 2048, the

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AORN JOURNAL JANUARY 1984, VOL 39, NO 1

Organ Procurement: You Can Help It’s after midnight. You are working in the trauma OR, trying to save a young auto accident victim. Soon it’s over. Nothing more can be done.

The question of organ donation arises. Who do you call? How can you talk to the family? You know there is an organ procurement agency nearby, but no one has the number.

Remember this toll-free hotline number-1-800-24DONOR. Sponsored by the North American Transplant Coordinators Organization (NATCO), the hotline is staffed 24 hours a day by organ procurement specialists at the University of Pittsburgh, a major transplant center.

“This is not an answering service,” said Brian Broznick, one of hotline staff.

The coordinator answering the phone will advise you about what action to take and offer to contact a transplant coordinator in your area. If you wish, the local coordinator will come to your hospital and assist you by talking to the family, maintaining the patient, and answering medical-legal questions.

the organ, identify potential donors, and dispatch an organ retrieval team.

‘‘At least 90% of our referrals come directly or indirectly from nurses, ’ ’ Broznick emphasized. The nurse may pick up the phone or gently encourage a reluctant physician to call.

The hotline augments the work of 36 organ procurement agencies in 22 states, which coordinate donations in their areas. Some 140 hospitals also have procurement programs.

The 450 members of NATCO are organ procurement specialists such as registered nurses, social workers, and paramedics. For current membership information, contact Amy Peele, RN, the current president, at Rush-Presbyterian-St Luke’s Medical Center, Section of Transplantation, 1753 W Congress Pkwy, Chicago, I11 60612. Phone: (312)

The hotline will make arrangements to obtain

942-6242.

Organ Procurement and Transplantation Act. Rep Edward Madigan (R-Ill) is the House spon- sor.

The

Senator Hatch’s bill would establish a private national registry to speed matching of patients with donors set up a task force to recommend private and public roles in transplantation have HHS report to Congress annually about transplant research and practice prohibit organ sales. Hatch bill would not expand federal reim-

bursement, as the Democrats’ would. Better referrals will not solve the transplant

problem. We are left with the issue of cost. How much is too much for a life-saving treatment? Blue Cross/Blue Shield and Medicare have balked at paying for the newer transplant surgeries-heart, heart-lung, and liver. They maintain the procedures are still experimental, despite the rapidly improving success rates.

In contrast, the insurers are eager to pay for kidney transplants. At about $40,000, a trans- plant is cheaper in the long run than maintaining a patient on dialysis at about $18,000 a year.

There are no such trade-offs with the newer procedures, because the alternative is death. And the costs are much higher. Blue Cross/Blue Shield sets the costs of heart transplants at $107,000 per case; heart-lung transplants at $129,000; and liver transplants at $240,000. Facing growing public pressure, the Mas- sachusetts Blues have started offering a special transplant certificate. Proposals for Medicare reimbursement for heart, liver, and pancreas transplants are slowly wending their way through the bureaucracy.

Commercial insurance companies have. moved faster. Almost all will pay for kidney, cornea, pancreas, and bone marrow transplants, according to a survey by the Health Insurance Association of America. About three-quarters pay for heart and liver procedures.

0 For the first time in five years, the Presi- dent has signed into law appropriations for the US Department of Health and Human Services (HHS). President Reagan signed the $90 billion bill in early November. In recent years, HHS has

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JANUARY 1984, VOL 39, NO I AORN J O U R N A L

operated under an unofficial budget called a con- tinuing resolution because Congress could not reach a consensus.

The new budget includes $5 1.77 million for nursing education, a compromise between Sen- ate and House. (President Reagan had recom- mended only $13 million.)

Of the total, Medicare and Medicaid account for almost two-thirds ofthe money. The National Institutes of Health appropriation of $4.3 billion and the Centers for Disease Control amount of $373 million are increases over last year. Re-

ceiving less are programs for maternal and child health, community health centers, the National Health Service Corps, and health maintenance organizations.

An amendment regarding abortions states, “None of the funds contained in this Act shall be used to perform abortions except where the life of the mother would be endangered if the fetus were carried to term. ”

PATRICIA PATTERSON LEGISLATIVE CONSULTANT

ANA Schedules Certification Exam The American Nurses’ Association (ANA) will administer certification exams for 17 areas of professional nursing practice and administration on two separate dates in 1984. The first test date is June 22, during ANA’s biennial convention in New Orleans, and the second date for the exam is Sept 29 in 67 cities nationwide. Test sites for the second exam are located in each of the 50 states, in Washington, DC, in Guam, and the Virgin Islands.

The 17 ANA certification programs for registered nurses are

community health nurse adult nurse practitioner family nurse practitioner school nurse practitioner gerontological nurse gerontological nurse practitioner maternal and child health nurse high-risk perinatal nurse child and adolescent nurse pediatric nurse practitioner medical-surgical nurse psychiatric and mental health nurse clinical specialist in medical-surgical nursing clinical specialist in adult. psychiatric and mental health nursing

clinical specialist in child and adolescent psychiatric and mental health nursing nursing administration nursing administration, advanced

As of January 1984, an anticipated 20,000 nurses will have been certified through ANA since its certification program inception in 1974. As a voluntary program for registered nurses, certification through the ANA offers evidence and recognition of advanced knowledge and skill in specialty areas of nursing.

Credentials acquired through certification verify commitment to professional standards and command the respect of other health care professionals, administrators, and the public. In addition, in some employment settings, certified nurses may have a salary differential over noncertified nurses.

Administered through a peer review system and written examinations, ANA certification measures each applicant’s expertise in current nursing knowledge, and in the consideration of and initiation of new alternatives and strategies in nursing practice and administration. Specific education and/or practice criteria are prerequisite for each specialized program offered.

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