The point system for organ distribution.

W HEN congressional hearings on transplantation were held by Congressmen Gore and Waxman in the autumn of 1983, the full implications were not obvious to many who testitied. Support for the proposed legislation was organized by Dr Oscar Salvatierra of San Francisco. Those who contributed to the Washington support of the legislation included officers of the American Society of Transplant Surgeons, Norman Shumway on behalf of the thoracic surgeons, many of the procurement coordinators, and myself (TES). There were three definable objectives. One was to increase the supply of organs with a small grants program that could strengthen procurement agencies already in existence or stimulate the development of new programs in underserved areas. An almost unnoticed proviso was the establishment of a national network for organ distribution. The second proposal was to pay for expensive medicines, such as the then new immunosuppressive agent cyclosporine. which had not yet been released by the FDA but which was predicted to be too costly for many patients to afford. The third issue was a prohibition on the buying and selling of organs. This was a specific response to an unpopular proposal by a Virginia physician that a kidney brokerage business be established through which recipients could negotiate with living donors on a commercial basis.