Health Care/Joan Retsinas

Organ Transplants and Competence: A Sad Tale

What do we want in government bureaucrats? nnPresident Trump wanted the two Cs: cronies and campaign contributors. They drove out career employees. Remember Jared Kushner’s failure to supply enough protective equipment to hospitals? Remember the mishmash over tests: not enough, followed by too many? At the Centers for Disease Control, the Department of Health and Human Services, the Food and Drug Administration, at Agriculture, Housing and Urban Development, Energy, and the State Department, loyalty to the chief was the criterion for many hires.

Mercifully, President Biden has chosen Competence.

After four years of a very Caucasian administration, many Americans are also pushing for another C: skin color, with its analog of culture. We veer, however, close to tribalism if we stock government solely by quotas, letting tribalism “trump” competence. When we add the Calpurnia test, seeking candidates purer than Caesar’s wife (though Calpurnia may not have been so pure), we further downplay competence.

Obviously we want bureaucrats to mirror the nation. President Biden has done that.

Let us laud those appointments, asking only that they can disseminate a life-saving vaccine quickly, efficiently, safely. When our lives depend on it — and they do — most Americans want competence over all other criteria.

What follows is a below-the-fold anecdote about the dangers of having too few knowledgeable people in the bowels of government: the sad bungling “reform” of organ donation.

To date, over 110,000 patients are on waiting lists for organs. At first glance, the problem seems simple: ramp up the number of organs harvested, then transplanted, The end result: lives saved. We “match” deceased patients with organs that can be saved, with moribund patients who need those organs. Included in the process are not just hospitals, but the 58 organ procurement organizations (OPOs) that collect and distribute the organs.

The Trump bureaucrats saw a simple solution: make transplants into a competitive race among the OPOs. That competitive drive spurs teams, spurs companies, spurs our former President’s minions. How easy: make it a race.

The bureaucrats-in-charge did just that. In December they instituted competition, where the “poorest performing” OPOs would close, and the remaining would expand. The press release promises to “ Hold Organ Procurement Organizations Accountable through Transparency and Competition.” Much as in “The Apprentice,” “underperforming OPOs” would lose, bowing out of the race.

This simplicity runs afoul of reality. The “organ” distribution system is complex, as experts — ignored experts — advised. The system requires not competition, but collaboration among hospitals and centers. The new rule has spurred an outcry from transplant surgeons: the reforms will lead to fewer lives saved.

The glitches are buried in the arcana of the organ transplant system. The new regulations focus only on the OPOs, not the hospitals. Hospitals are key, but the reforms overlook them. Some helpful regulations would have required hospitals to maintain patients on life-support long enough to salvage their organs, would have required all parties to jettison the telephone-contact for alerting OPOs of organs in favor of the computer, would have allowed use of hard-to-salvage organs that we now reject, but that European hospitals salvage. Transplant experts now warn of “chaos.” If we eliminate as many as eight OPOs under the banner of competition, we will have fewer transplants. Transplant experts now warn of chaos. The decision-makers did not foresee the consequences.

As we scramble to vaccinate millions of Americans, we will need to forge collaborative networks among states, laboratories, transit, hospitals, physican offices, pharmacies, housing developments, schools, and workplaces, with a nationwide data system to track numbers served. For “herd immunity,” we need to vaccinate as many as 75% of the population — a herculean endeavor that will work only if the best and brightest, at all levels of government, are in charge. Surely, this is a time for competence.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email retsinas@verizon.net.

From The Progressive Populist, February 1, 2021

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