Organ Transplant Expert Eyes Compromise

By Janice Crompton

Post-Gazette Staff Writer

At first glance, Mary Ann Palumbi seems like any other hard-working wife and mother. She and her husband, Edward A. Gill, are working to put their 18-year-old son Benjamin through college, while enjoying country life on six scenic acres in Nottingham.

The couple commutes daily to Pittsburgh, he to the Art Institute of Pittsburgh, where he's the dean of education, and she to Allegheny General Hospital, where she has a much different responsibility.

Lately, Palumbi has found herself in the middle of a national maelstrom over who should receive organ transplants, and when.

An ongoing debate about transplant organ allocation has raged in recent months between Congress and the U.S. Department of Health and Human Services, but the fight has slowly zeroed in on Pittsburgh, where one hospital and several transplant organizations are battling.

Palumbi, a 47-year-old registered nurse, has found herself caught up in the fray through her ties to two organizations: the North American Transplant Coordinators Organization, where she is immediate past president, and the United Network of Organ Sharing, where she is a board member.

UNOS, a Richmond, Va.-based nonprofit organization, has been the national network that oversees organ transplant services since 1986, when it won a government contract mandated by the National Organ Transplant Act of 1984. Every three years since, the organization's contract has been renewed, chiefly because it faced little competition.

Now, though, the issue of organ allocation is being challenged. UNOS allocates organs differently, depending on the type of organ being donated, and the location and medical condition of donors and recipients.

The organization has been at odds with the University of Pittsburgh Medical Center and others, who want to change organ allocation to a "sickest first" policy.

Earlier this month, two Pittsburgh companies, Management Services Inc., and CONSAD Research Corp., announced they would form a nonprofit company that would vie for the government contract, which expires at the end of the year.

The new company, the Center for the Support of the Transplant Community, along with UPMC, argues that organs should go to the sickest patients first, regardless the location of their hospital.

Palumbi, though, said that while that would be the ideal solution, there are other factors to consider.

Palumbi said that allocation from a national list could mean a waste of organs, and "we just can't afford that right now." She said 67,000 patients in the United States are awaiting organs, including kidneys, livers and hearts.

She said UNOS instead is backing a compromise and has begun implementing a plan that would expand regions and recipient lists, so organs will not be wasted. With a broad "sickest first" policy, she said, valuable time and lives could be lost because donated organs are viable for transplantation only for a short time.

Palumbi became involved in organ transplant in 1973, when she worked as an intensive care unit nurse at Presbyterian University Hospital. Within two years, she was promoted to head nurse, and shortly afterward was approached by the hospital to become involved in its transplant services.

"At that time, all we'd had was renal transplant," Palumbi recalls. "It was something very, very new. In those days, it was a bigger deal, but today, we send some patients home after five days."

By 1987, Palumbi, the daughter of a Pittsburgh city police lieutenant who grew up in Brookline, was recruited by Allegheny General Hospital to start a transplant program there. She's been with the hospital since, and now serves as its senior director of transplantation services.

Twenty years ago, she joined NATCO, which developed the computer system used by UNOS to help match organ donors and recipients nationwide.

Even with all the controversy now surrounding organ transplant, Palumbi said she's excited about the program she helped to develop at Allegheny General, and said she's looking forward to the promise of new advances in the constantly evolving arena of organ transplantation.

"It's an ever-changing field, so there's always something new and exciting coming up," she said.

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This article posted July 12, 2000.