Transplant Allocation

I couldn't sleep last night, so I picked up an old issue of Congressional Quarterly, dated circa 1998. I read an article about (then) proposed regulations that would require harvested organs to be routed to the sickest patients in the nation, regardless of location. The status quo had been to first check regional waiting lists. I haven't had time today to research what the current policy is, but I intend to do so in the next few days. Meanwhile, here are some of my thoughts about the article I read last night:

• The smaller, more rural transplant centers were against the proposed legislation, arguing that it would take organs out of their territory, result in fewer successful transplants and reduce the motivation of local organ procurement doctors. Naturally, the big city hospitals (specifically cited: UPMC) were in favor of the legislation, as it would route more organs to their hospitals and also increase revenue. It's hard to blame either side for wanting the best for their respective medical organizations.
• There seemed to be a debate within the medical community about whether or not longer transportation of harvested organs would adversely affect transplants. Experts were cited on both sides of the issue.
• The ethical questions are difficult, I think: Is it proper to provide organs to those that are most sick, or to those that are most likely to live successfully with a transplanted organ? Who should be making these decisions? Doctors? Lawyers? Politicians? Patients?
• Ultimately, a choice is being made by someone or some body made up of people to allocate a vital limited resource (donated organs) to a field of unlimited wants (patients wanting to live longer). This is an economic question. Would a free market solution work better than the status quo? I believe it is now currently illegal to buy and sell organs, but perhaps an "organ market" would give the allocation process more transparancy than otherwise possible under any other approach. Still, it sounds pretty creepy.
• I am interested in obtaining the opinion of my Dad, who has had two kidney transplants and a pancreas transplant. Also, my aunt Kak, whom I will be visiting at Thanksgiving, works as a grief counselor for an organ donor organization, Lifebanc.

Here are some links regarding organ transplantation:

How Stuff Works has a good article about organ transplantation

The United Network for Organ Sharing is the nonprofit firm that contracts with the Department of Health and Human Services to manage the national organ procurement and allocation programs. The've developed a technology, UNet, to manage data regarding transplants. I'd like to read more about this system.