Under Kidney Transplant Proposal, Younger Patients Would Get the Best Organs

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By Rob Stein
The nation's organ-transplant network is considering giving younger, healthier people preference over older, sicker patients for the best kidneys.

Instead of giving priority primarily to patients who have been on the waiting list longest, the new rules would match recipients and organs to a greater extent based on factors such as age and health to try to maximize the number of years provided by each kidney - the most sought-after organ for transplants.

"We're trying to best utilize the gift of the donated organ," said Kenneth Andreoni, an associate professor of surgery at Ohio State University who chairs the committee that is reviewing the system for the United Network for Organ Sharing (UNOS), a Richmond-based private nonprofit group contracted by the federal government to coordinate organ allocation. "It's an effort to get the most out of a scarce resource."

The ethically fraught potential changes, which would be part of the most comprehensive overhaul of the system in 25 years, are being welcomed by some bioethicists, transplant surgeons and patient representatives as a step toward improving kidney distribution. But some worry that the changes could inadvertently skew the pool of available organs by altering the pattern of people making living donations. Some also complain that the new system would unfairly penalize middle-aged and elderly patients at a time when the overall population is getting older.
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UM Panel: Rethink End-of-Life Priorities - Health - MiamiHerald.com

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As people live longer with the help of technological advances, end-of-life care will take an increasingly large bite out of the nation's healthcare budget -- unless we change the way we treat dying patients and their families, according to a panel Thursday at the University of Miami's Global Business Forum. Three medical doctors, a CEO and a professor of religious studies debated the economics and ethics of end-of-life decisions, warning that the care model historically used by the medical establishment needs to be improved in a world where there are more elderly people with more chronic illnesses. The emphasis, they agreed, should be on a team-oriented holistic approach tailored to the patient and his or her last wishes.
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The Health Care Blog: Interview: TR Reid on healthcare reform around the world

TR Reid is a former foreign correspondent with the Washington Post. He spent two years (partly funded by the Kaiser Family Foundation) looking at health care systems across the world and has been featured heavily in many media venues lately asking the simple question, if everywhere else can cover everyone at half the cost, how do they do it?

His book is called The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care and here's an interview he did as part of Frontline's Sick Around The World.

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Health Affairs Blog-Fact or Fiction Advance Care Planning in Health Reform

by Chris Fleming

Patients with serious or advanced illnesses would be given more control over their care by language in health reform legislation passed by three House committees that would pay physicians, nurse practitioners, and other providers for counseling Medicare beneficiaries about advance planning for future care decisions.

That was the unanimous opinion expressed by three respected geriatricians at a August 20 conference intended to clarify several issues at the heart of the current health reform debate. The conference, Fact vs. Fiction: Key Issues in Health Reform, was sponsored by Health Affairs. The participants in the panel dealing with end of life issues were Christine Cassel, MD, President, American Board of Internal Medicine; Diane E. Meier, MD, Director, Center to Advance Palliative Care, Mount Sinai School of Medicine; and Jerald Winakur, MD, of the Center for Medical Humanities and Ethics at the University of Texas Health Science Center and author of “What Are We Going To Do With Dad?,” a Health Affairs 2005 Narrative Matters essay.

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Another Drug Maker to Report Payments to Doctors

Posted by Jacob Goldstein in the Wall Street Journal Health Blog The pharma transparency bandwagon is filling up, as drug makers pile on to report their payments to physicians. Now GlaxoSmithKline has climbed aboard, the Financial Times reports . Besides publicly reporting what the company pays docs (presumably for things like consulting and giving speeches), Glaxo will also cap payments at $150,000 per year. Merck and Eli Lilly are among the companies that have already said they’ll make public at least some of their payments to doctors. Transparency could soon be forced on the whole industry, willing or unwilling: The Physician Payment Sunshine Act, sponsored by an influential senator, Chuck Grassley, would require drug and device makers to regularly report their payments to doctors.