Organ transplants. Who should get them? Who should pay?

The National Organ Transplant Act, passed last fall, establishes a federal task force to review public and private policy on organ procurement, provides funds for a national network to match organ donors with patients needing transplants, and sets up a registry of organ transplant recipients. Dropped from the bill before it left Congress, however, were controversial provisions that would have established Medicare and Medicaid policy on transplantation. For Medicaid, the bill would have required state agencies to establish written policies that would apply uniformly to all persons in the respective states. What happens now is up to individual states. Some have established policies. But others still face agonizing and politically sensitive questions about who is eligible for transplants and who will pay the bills; they are making decisions on a case-by-case basis. The expense of transplants is a major issue, of course. As one commentator puts it: "Two hundred thousand dollars for one transplant would cover the Medicaid expenses for 500 AFDC children in a year's time." What should the states do? Who should be financially responsible for people who need transplants? When human lives hang in the balance, what factors should be considered?