Rules for Transplants

State panel won't veto would-be donors

By Roni Rabin

September 27, 2003

In drafting new rules for transplants using live liver donors, the state health department has backed away from an earlier proposal that an independent advocacy team has the right to overrule an individual's wish to become a donor.

The revised proposal now creates the advocacy teams, which are to represent the donor's interest, but it does not give the teams veto power over a would-be donor. The proposal is one of a series of regulations aimed at safeguarding the health and rights of living donors.

The state also rejected an earlier proposal setting a donor age limit of 55. A health department spokesman said the only criterion should be the donor's health.

The rules follow the death on Jan. 13, 2002, of Michael Hurewitz, a 57-year-old Albany man who had donated part of his liver to his brother, a Long Island doctor. A state health department report characterized Michael Hurewitz's postoperative care at Mount Sinai Hospital's understaffed transplant unit as inadequate and fragmented, and suspended its liver donor program until last spring.

A lawyer representing Hurewitz's widow, Vickie, who has campaigned for more rigorous government oversight, said one of her prime concerns is that the live donor process "is rife with conflicts of interest."

"It may be against their own best interest to donate, but they may have to live with the thought that they may be responsible for the death of a loved one," said the lawyer, Steven B. Samuel, of New Hyde Park.

The state's proposed rules require hospitals to create the advocacy teams, consisting of an independent physician, medical social worker, transplant coordinator and psychiatrist, to make sure the potential donor understands the risks and is not being coerced. A two-week waiting period is then imposed.

The regulations, which are open to public comment for 45 days, will go before the State Hospital Review and Planning Council on Dec. 4. It will recommend for or against approval to the health department, state officials said. The five hospitals that perform live liver transplants have already implemented them, health officials said.

The state's proposed rules also set new standards and staffing requirements for the surgical and nursing teams, and make requirements for post-operative and follow-up care.

The health department's Committee on Quality Improvement in Living Liver Donation had originally recommended that the advocacy teams have the power to overrule a potential donor. A spokesman for the state health department said the committee members were involved in reversing that recommendation.

"There was concern over third parties interfering with the intimate and critical relationship between a patient and a physician," state health department spokesman William Van Slyke said, referring to the transplant surgeon or team.

But Samuel said the transplant surgeon has a conflict of interest, because he is treating the very ill patient who needs the organ and because he is usually eager to perform a transplant.

Still, he said, his client, Vickie Hurewitz, would be pleased with some of the other proposed regulations, including a requirement that hospitals track donors' health and report the data to the health department, and that they have one nurse for every two patients, whether donors or recipients, in intensive care.

Some 2,247 New Yorkers are on a transplant list waiting for a liver, but there is a shortage of cadaver livers.

Copyright (c) 2003, Newsday, Inc.


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