Technology Assessment,Public Policy and Transplantation: A Restrained Appraisal of the Massachusetts Task Force Approach

Report of the Massachusetts Task Force on Organ Transplantation, Department of Public Health, Commonwealth of Massachusetts, October 1984 [hereinafter referred to as Task Force Report]. Sections I, II, IV and VII of the Task Force Report were published in Law, Medicine & Health Care 13(1):8–26 (February 1985).

Annas G.J. , Regulating Heart and Liver Transplants in Massachusetts: An Overview of the Report of the Task Force on Organ Transplantation, Law, Medicine & Health Care 13(1):4 (February 1985) [hereinafter referred to as Annas].

Casscells W. , A Clinician's View of the Massachusetts Task Force on Organ Transplantation, Law, Medicine & Health Care 13(1):27–28 (February 1985); Pauly M.V. , Equity and Costs, Law, Medicine & Health Care 13(1):28–31 (February 1985); Miller F.H. , Reflections on Organ Transplantation in the United Kingdom, Law, Medicine & Health Care 13(1):31–32 (February 1985); Caplan A.L. , If There's A Will, Is There a Way? Law, Medicine & Health Care 13(1):32–34 (February 1985); Kissick W.L. , Organ Transplantation and the Art of the Possible, Law, Medicine & Health Care 13(1):34–35 (February’ 1985); Skelley L. , Practical Issues in Obtaining Organs for Transplantation, Law, Medicine & Health Care 13(1):35–37 (February 1985); Jonsen A.R. , Organ Transplants and the Principle of Fairness, Law, Medicine & Health Care 13(1):37–39 (February 1985).

See, Evans R.W. , Issues in Liver Transplantation, Lancet 2(8362):1306 (December 3, 1983); Evans R.W. , Cyclosporine in Cadaveric Renal Transplantation, New England Journal of Medicine 311(2):127 (July 12, 1984); Evans R.W. , Organ Transplantation, Science 222(4621):234 (October 21, 1983) [hereinafter referred to as Organ Transplantation]; Evans R.W. , The Need for and Supply of Donor Hearts for Transplantation, Journal of Heart Transplantation 4(1):57 (November 1984) [hereinafter referred to as Need for Hearts];, Evans R.W. Manninen D.L. Hart L.G. , A Comparative Assessment of the Quality of Life of Successful Kidney Transplant Patients According to Source of Graft, Transplantation Proceedings 16(5):1353 (October 1984); Evans R.W. Garrison L.P. Manninen D.L. , The National Kidney Dialysis and Kidney Transplantation Study: Study Description, State of Objectives, and Project Significance, Part I, Contemporary Dialysis 3(6):55 (June 1982); Evans R.W. Garrison L.P. Manninen D.L. , The National Kidney Dialysis and Kidney Transplantation Study: Study Description, Statement of Objectives, and Project Significance, Part II, Contemporary Dialysis 3(9):36 (September 1982); Evans R.W. , The Quality of Life of End-Stage Renal Disease Patients, New England Journal of Medicine, 312(9):553 (February 28, 1985); Evans R.W. , The Quality of Life of Kidney and Heart Transplant Recipients, Transplantation Proceedings 17(1):1579 (February 1985); Garrison L.P. Hart R.W. Manninen D.L. , Income and Poverty Among End-Stage Renal Disease Patients: Results from the National Kidney Dialysis and Kidney Transplantation Study, Health Affairs (in press); Overcast T.D. , Problems in the Identification of Potential Organ Donors: Misconceptions and Fallacies Associated with Donor Cards, Journal of the American Medical Association 251 (12): 1559 (March 23/30. 1984).

Blagg C.R. , Editorial: Dialysis or Transplantation? Journal of the American Medical Association 250(8):1072 (August 26, 1983) (hereinafter referred to as Dialysis or Transplantation], Evans R.W. , Economic and Social Costs of Heart Transplantation, Heart Transplantation 1(3):243 (May 1982) [hereinafter referred to as Costs]; Evans R.W. , Health Care Technology and the Inevitability of Resource Allocation and Rationing Decisions, Part I, Journal of the American Medical Association 249(15):2047 (April 15, 1983); Evans R.W. , Health Care Technology’ and the Inevitability of Resource Allocation and Rationing Decisions, Part II, Journal of the American Medical Association 249(16):2208 (April 22/29, 1983) [hereinafter referred to as Technology]; Evans R.W. , Heart Transplants and Priorities, Lancet 1(8381):852 (April 14, 1984); Evans R.W. Anderson A. Perry B. , The National Heart Transplantation Study: An Overview, Heart Transplantation 2(1):85 (November 1982) [hereinafter referred to as Overview of Transplantation Study]; Evans R.W. Blagg C.R. Bryan F.A. , Implications for Health Care Policy: A Social and Demographic Profile of Hemodialysis Patients in the United States, Journal of the American Medical Association 245(5):487 (February 6, 1981) [hereinafter referred to as Demographic Profile];, Evans R.W. , Final Report: The National Heart Transplantation Study (Battelle Human Affairs Research Centers, Seattle, WA) (1984) [hereinafter referred to as Final Report]; Frohboese R. Overcast T.D. , Legal Issues Relating to Health Psychology in Health Psychology: A Discipline and a Profession ( Stone G.C. , eds.) (University of Chicago Press. Chicago) (1985) (in press); Overcast T.D. Merrikin K.J. Evans R.W. , Malpractice Issues in Heart Transplantation, American Journal of Law & Medicine 10(4):362 (Winter 1985).

For example, the American Council on Transplantation, the Surgeon General's Conferences, and NIH Consensus Conferences. See also Demographic Profile, supra note 5; Dialysis or Transplantation supra note 5, at 1072–73.

Annas , supra note 2, at 5.

Task Force Report, supra note 1, at 9.

Landesman S.H. Ginzburg H.M. Weiss S.H. , The AIDS Epidemic, New England Journal of Medicine 312(8):521 (February 21, 1985); Centers for Disease Control, Update: Acquired Immunodeficiency Syndrome (AIDS)—United States, Morbidity and Mortality Weekly Report, 32:688 (1984), Selik R.M. Haverkos H.W. Curran W.J. , Acquired Immune Deficiency Syndrome (AIDS): Trends in the United States, 1978–1982, American Journal of Medicine 76(3):493 (March 1984).

Task Force Report, supra note 1 at 9.

See Technology, supra note 5, at 2047-53, 2208–19.

Id.

See Costs, supra note 5; see also Final Report, supra note 5, at vol. 3; Pauly, supra note 3, at 38.

Annas , supra note 2, at 6. “[T]he Task Force derived costs of $230,000 to $340,000 per liver transplant patient alive at the end of one year (using a 70 percent survival rate), and $170,000 to $200,000 per one-year survival for heart transplant patients…. Additional years of survival would add from $10,000 to $20,000 in costs per year to these figures.”

Final Report, supra note 5, at vol. 3.

Annas , supra note 2, at 6.

Final Report, supra note 5, at vol. 3.

See Task Force Report, supra note 1, at 6. Although it is a relatively minor point, we do not agree with the Task Force's assertion that “[o]n the federal level, almost exclusive energy is being devoted to increasing the supply to [sic] transplantable organs by making the organ procurement system more efficient.” Id. Federal support continues at a relatively high level for research on many diverse aspects of transplantation, including most recently the solicitation of proposals for projects concerning the long-term costs, and effectiveness of kidney, bone marrow, and other organ transplantation. 50 Fed. Reg. 4480 (January 30, 1985). See also, Need for Hearts, supra note 4, at 59; Costs, supra note 5, at 250; Final Report, supra note 5, at vol. 2.

Final Report, supra note 5, at vol. 2.

Id.

Id.

Id.

Id. See also Demographic Profile, supra note 5, at 487.

Annas , supra note 2, at 7.

Overview of Transplantation Study, supra note 5, at 85; Organ Transplantation, supra note 4, at 234; Final Report, supra note 5.

Organ Transplantation, supra note 4, at 234; Overview of Transplantation Study, supra note 3, at 86; Technology, supra note 5.

Final Report, supra note 5.

Annas , supra note 2, at 4.

Id. at 7.

Final Report, supra note 5, at vol. 4, ch.34, §3; Overcast T.D. Sales B.D. Pollard M.R. , Applying Antitrust Laws to the Professions: Implications for Psychology, American Psychologist 37(5):517 (May 1982); Blumstein J.F. , Rationing Medical Resources: A Constitutional, Legal, and Policy Analysis, Texas Law Review 59(8):1345 (November 1981).

Herbsleb J. Sales B.D. Overcast T.D. , Challenging Licensure and Certification, American Psychologist (in press).

See, e.g., Hyde v. Jefferson Parish Hosp. Dist. No. 2, 104 S. Ct. 1551 (1984) (anesthesiologist). Among the specialties currently offered under exclusive staffing arrangements are radiology, nuclear medicine, pathology, anesthesiology, renal dialysis, emergency room service, and major surgery. See Final Report, supra note 5.

Moore F.D. , Letter to the Editor: MGH Trustees Say No to Heart Transplants, New England Journal of Medicine 303(17):999 (October 23, 1980).

See Whalen v. Roe, 429 U.S. 589, 604 n. 33 (1977) (addressing doctors’ assertions that they have a right to administer medical care).

Havighurst C. , Competition in Health Services: Overview, Issues and Answers, Vanderbilt Law Review 34(4):1117, 1148 (May 1981).

Moore F.D. , How Much Cardiac Transplantation—And Where? Heart Transplantation 1(4):254 (August 1982).

For an extended discussion of this issue see Blumstein J. , Rationing Medical Resources: A Constitutional Legal and Policy Analysis, Texas Law Review 59:1345(1981); and Rosenblatt R. , Rationing “Normal” Health Care: The Hidden Legal Issue, Texas Law Review 59:1401 (1981).

See e.g., Matthews v. Eldridge, 424 U.S. 319 (1976).

Merrikin K.J. Overcast T.D. , A Right to Decide to Undergo Particular Medical Procedures as an Aspect of the Right to Privacy: Implications for Regulation of Heart Transplantation and Other Forms of Medical Technology, Journal of Contemporary Law (in press).

See Estelle v. Gamble, 429 U.S. 97 (1976).

Task Force Report, supra note 1, at 13.

Andrews v. Ballard, 498 F. Supp. 1038 (S.D. Tex. 1980); People v. Privitera, 591 P.2d 919, cert. denied, 444 U.S. 949 (1979); Rutherford v. United States, 438 F. Supp. 1287 (W.D. Okla. 1977), aff'd, 582 F.2d 1234 (10th Cir. 1977), rev'd, 442 U.S. 544 (1979); Suenram v. Society of Valley Hospital. 155 N.J. Super. 593 (1977).

Id.

42 U.S.C. §§6101-6107 (1982).

Final Report, supra note 5, at vol. 4, ch. 32, §2.

See 42 U.S.C. §6103(b)(2) (“any law” exclusion); 42 U.S.C. §6103(b)(1)(A) (“normal operation” exclusion); 42 U.S.C. §6103(b)(1) (“reasonable factors other than age” exception).

42 U.S.C. §§2000(a)-2000(d)4 (1982).

Merrikin K.J. Overcast T.D. , Patient Selection for Heart Transplantation and the Federal Handicap Discrimination Law, Journal of Health Politics, Policy & Law (in press); Crane K. , Section 504 of the Rehabilitation Act of 1973: Is It Authority for Federal Intervention in the Area of Medical Decision-Making? Capital University Law Review 13(4):645 (Winter 1984).

42 U.S.C. §§2000(a)-2000(d)4 (1982) See also 45 C.F.R. §§80.1-80.13 (1984).

See generally, Fullilove v. Klutz nick, 448 U.S. 448 (1980); Lora v. Board of Education of New York, 603 F.2d 248 (2d Cir. 1980); Parent Association of Andrew Jackson High School v. Amback, 598 F.2d 705 (2d Cir. 1979).

Capian, supra note 3, at 32.