Beth Israel Deaconess Medical Center Hopes To Establish 'Model' Live Medicine Center in Boston

Amid a controversy sparked by nationwide liver-donor shortages and a fevered public policy debate, Beth Israel Deaconess Medical Center (BIDMC), a Harvard Medical School affiliate, announced the creation of a "multidisciplinary" liver medicine center to bring needed care to Boston-area liver patients.

The incoming chief of the new center, Dr. Maureen Martin, said she hopes her team of doctors, nurses and researchers will build the strongest program in Boston, "one that can serve as a model for the rest of the nation."

Martin said one of her objectives is opening Boston's first pediatric liver program at her center.

She also said she hopes to begin a "living-donor program" that transplants parts of the liver from one living person into the liver of another. Her center, she said, has recruited an expert in this field.

When the new center opens later this month, it will find itself embroiled in a national dispute over how to best handle the allocation of liver donations and transplants.

At the conflict's core is a proposal by U.S. Secretary of Health and Human Services, Dr. Donna E. Shalala.

Shalala wants to begin making donated livers available for the sickest patients across the nation--the sicker you are, wherever you are, the better chance you'll get a new liver.

The current policy allows only the sickest transplant candidates within the donor's geographic region to be given priority for the liver.

Shalala said she hopes her proposal will reduce shortages of the organ throughout the country. In 1998 alone, 1,319 Americans died while awaiting necessary liver transplants.

Under Shalala's proposal, livers would be made available first locally, then regionally and, finally, nationally--with the most ill patients getting top priority.

Under the National Organ Transplantation Act of 1984, Shalala has the power to set the rules governing the allocation of transplanted organs.

Unless prevented to do so by an act of Congress, Shalala said she will try to implement this policy change in the near future.

Most liver programs, especially smaller ones, generally support the current allocation process because it directs more transplant patients their way than would a system considering the sickest nationwide.

Martin's team, which will attempt to rebuild the BIDMC liver program following the departure of the hospital's previous liver transplantation team, is among the advocates of the status quo.

A few larger programs, those serving large numbers of extremely sick liver patients, favor Shalala's plan because it would increase their share of transplant operations.

Both groups have been aggressively lobbying lawmakers in Washington.

Martin said it was unclear how BIDMC's liver program will ultimately be affected by this controversy.

She said, however, that she does not expect any policy changes any time soon.

Instead, she said she is concentrating on her goal to "get liver programs in Massachusettes to work together and get the cooperative spirit going in Boston."