Saturday, February 17, 2007

Politicians and Transplantation

Politics is as much a part of transplantation as it is of any other part of life, transplant is arguably the most politicized and regulated field of medicine, and politicians have played many roles in the history of transplantation.

The most obvious role is that of transplant recipient. Like thousands of their constituents, several politicians have faced the seriousness of end-stage organ failure and experienced organ transplantation firsthand. The first politician to receive a transplant (that I know of) was Kansas City Mayor John Reardon, who received a heart transplant in February 1987. The next prominent example was Pennsylvania Governor Robert Casey, who received a heart-liver transplant for amyloidosis in June 1993. More recently, Texas state Senator Mario Gallegos (D, Houston) received a liver transplant last month for alcoholic cirrhosis. Questions of preferential treatment were raised when both of these politicians received their transplants surprisingly soon after being listed, but no evidence of favoritism was found, though Governor Casey's case led to changes in the allocation rules for those waiting for multiple lifesaving organs. Representative Charles Norwood (R, GA) unfortunately died of cancer this past week, having received a single lung transplant for idiopathic pulmonary fibrosis in October 2004. In Canada, Quebec finance minister Michel Audet received a heart transplant in 1992 and retired a few days ago on Valentine's Day. There may be more transplant recipients who are politicians that I've missed (feel free to leave comments), and the overall number isn't huge given the number of politicians. But at least some of those making laws and running the government do so with the perspective of a transplant patient.

Fewer transplant professionals have been politicians, since doing so means choosing to change careers, an entirely different decision than choosing to treat a serious illness. The only one I'm aware of is Senator Bill Frist (R, TN) who was a heart and heart-lung transplant surgeon at Vanderbilt University Medical Center before being elected to the Senate in 1994, and intends to return to medical practice since his term ended in 2006.

Finally, even without firsthand experience, many politicians have played major roles in the development of transplantation in the United States. Transplantation greatly expanded in the early 1980s with the development of cyclosporine--kidney transplant success rates went from 50% to 80-90% at one year, and liver, heart, and lung transplants first reached viable success rates and wide application in these years. Increased success and increased application led to dramatically increased demand, which until that time had been met by smaller, local systems with few uniform processes and little sharing across geographical areas. In response to a number of pleas for donor organs, many directed to him, President Ronald Reagan [1][2][3][4][5] directed Congress to devise a system for organ allocation in the United States, which took shape in the National Organ Transplant Act of 1984, written by then-Congressman Al Gore. The development and implementation of the Act reflected tension between the Republican administration and the Democratic congress, ultimately resulting in the government not taking control of organ allocation, but assigning the responsibility to a private contractor: UNOS.

By the late 1990s, transplantation had expanded futher and the disparities in organ allocation between different regions of the country had become even wider, which led Secretary of Health and Human Services Donna Shalala to propose changes to the system that would require sharing across regional boundaries and give organs preferentially to the sickest patients first rather than those who had been waiting the longest. Like the National Organ Transplant Act of 15 years before, this legislation provoked controversy as smaller units (transplant centers and states) feared giving up control to larger ones, and private organizations such as UNOS were wary of increased governmental control. The tables were slightly reversed at this point, with a Democratic administration and Republican congress, which allowed this stronger legislation to pass in the form of the 2000 Final Rule.

They've been under attack in transplantation, like in every other part of society, but the influence of politicians has seemed to make things better for the transplant community. Unfortunately, there are many problems that still remain to be solved, so hopefully politicians of the future will have the interest and fortitude to tackle them. And we haven't had a transplanted president...yet.

2 comments:

TC said...

Thanks for the comments. I like your blog a lot, and am going to link to yours.

Senger said...

I had a heart transplant on 2/6/07 & am rejecting the heart. I have both cellular & vascular rejection. I am currently being treated by plasma -apheresis & gamma globulin therapy. I am insured by Medicare & they are refusing to pay for the treatments. They run $1,500 to $2,500 per series. has anyone had any experience with this problem in the USA>I had a heart transplant on 2/6/07 & am rejecting the heart. I have both cellular & vascular rejection. I am currently being treated by plasma -apheresis & gamma globulin therapy. I am insured by Medicare & they are refusing to pay for the treatments. They run $1,500 to $2,500 per series. has anyone had any experience with this problem in the USA>
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