Wading Into Fray On Organ Allocation

By Christopher Snowbeck

Post-Gazette Staff Writer

The debate is over how to allocate body organs for lifesaving transplant operations.

On one side are large transplant centers, such as the University of Pittsburgh Medical Center, which have argued for broad sharing of organs in hopes that the sickest patients in the country will get first dibs.

On the other side are small transplant centers, which have argued for maintaining an allocation system in which many organs are distributed first within smaller geographical areas before being offered across the country. The small centers argue that broader sharing of organs could lead to more organs being wasted, as sicker patients get organs that must be shipped hundreds of miles.

It's an entrenched debate that has prompted Donna Shalala, secretary of the U.S. Department of Health and Human Services, to call for changes that would bring broader sharing of organs. Her efforts, in turn, have been stymied by congressional leaders sympathetic to the plight of small centers.

Into all of this walked Mark Joensen last week, bringing with him two Pittsburgh companies that want to win the federal contract to manage the nation's organ transplant system.

Is there any hope for common ground? :

Joensen is leading a Pittsburgh-based initiative to win the contract for managing the nation's organ transplant network.

"I hope we can get past the allocation issue and move on to the most important thing, which is increasing organ donation."

Education: Ames High School, 1982; bachelor's degree in electrical engineering, Iowa State University, 1986; master's degree in physics, Carnegie Mellon University, 1988; doctorate in theoretical physics, Carnegie Mellon University, 1996.

"I think there certainly is the hope for it and it really relies on setting up a process where everyone is involved," Joensen said. "The fact that we have been dealing with this allocation issue within the organ transplant community for the better part of a decade is really a failure of the system."

Joensen, 36, is a vice president of CONSAD, an East Liberty public policy group that announced last week a partnership with Management Science Associates of Point Breeze. They will bid for the federal contract to manage the transplant system.

The contract is currently held by the Richmond, Va.-based United Network for Organ Sharing. It has held the job since 1986 and is working under a one-year extension of its current three-year contract.

Some aren't sure if CONSAD can play the role of mediator in the transplant wars.

"The stuff that CONSAD has done has been understood within the transplant community as being done under the direction of the University of Pittsburgh," said Joel Lee, executive director of communications for Vanderbilt University Medical Center in Nashville, Tenn. Vanderbilt has often weighed in on the side of small transplant centers in the debate.

Between 1993 and 1998, Joensen developed models for how different types of liver allocation policies would affect the total number of transplant patients who died. Joensen's results argued in favor of Pitt's prescribed remedy: Develop allocation policies that ensure similarly sick patients will receive organ transplants after waiting about the same amount of time, no matter where they go in the country for a transplant.

Joensen and CONSAD have done other work on transplant issues. The company has studied survival rates as well as variations in organ procurement rates across the country.

Alfred A Kuehn, chairman and founder of Management Science Associates, said Joensen's experience is key to the success of the proposed nonprofit group, called the Center for the Support of the Transplant Community.

"Mark Joensen has a lot of knowledge about the particular process and what's being done here and he can also bring in a lot of other experts in this area," Kuehn said.

At the same time, Kuehn resisted the characterization that the new group has taken sides on the transplant debate.

"I certainly don't see myself on one side or the other," he said. "I don't see it as the solution that one side has or the other side has. I think we're looking at developing a capability that gives a range of solutions that the powers that be can select from and modify."

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This article posted June 22, 2000.