It is time to consider a fundamental reexamination of the US system
for transplantable organ procurement and allocation. This need arises from
several important issues, including whether regional vs national allocation
policies best ensure fair access to available organs; the alleged problems
in procurement of human tissue under investigation by the Inspector General
of the US Department of Health and Human Services1,2;
the application of new technologies for growing human pluripotent stem cells
that may one day allow the manufacture of replacement organs and tissues autologous
to their recipients; and perhaps most important, weaknesses and tensions in
organ procurement policies that have produced chronic problems and shortfalls
in the availability of life-saving solid organs. The article by Wendler and
Dickert3 in this issue of THE JOURNAL is the
latest indication of concerns about equity, reliability, and efficacy in organ
procurement and transplantation that must stimulate change.
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