Report of the Massachusetts Task Force on Organ Transplantation

Coverage and reimbursement for heart transplantation

From the perspectives of coverage and reimbursement, heart transplantation has been a serious concern of policymakers in the U.S. since 1980, the year it was decided that a comprehensive study was required before the Health Care Financing Administration (HCFA), the federal agency responsible for the administration of the Medicare program, would be able to decide the status of the procedure (14;15;30;35). It was well acknowledged that the issues surrounding this decision were complex and that initial attempts to resolve the underlying coverage issue seemed to be too narrowly construed. It was at this time that the late Patricia Roberts Harris, then Secretary of the Department of Health and Human Services (DHHS), declared that DHHS would require new technologies to pass muster on the basis of their “social consequences” before “financing their wide distribution” (30). In a very special sense, although not appreciated at the time, a new era of health care technology assessment was ushered in, as Harris proclaimed that the then-conceived study of heart transplantation should serve as the “prototype” of technology assessment.

The dog and his shadow: a response to Overcast and Evans

Aesop‘s Fable, “The Dog and the Shadow,” begins with a dog walking over a bridge with a piece of meat in his mouth. Looking down into the stream, he sees his shadow. Thinking it is a bigger dog, with a piece of meat twice the size of his own, the greedy dog decides to get it. Snarling, he opens his mouth to attack. At that moment the meat falls from his mouth, into the stream. The dog realizes his mistake, and sadly says to himself, “Grasp at the shadow and lose the substance.“

Drs. Overcast and Evans have not yet realized their mistake, but this response may help them see that what they characterize as their “strong exception” to “procedural and substantive” points made by the Massachusetts Task Force on Organ Transplantation and the “major shortcomings” they purport to identify really involve insubstantial “shadows.” Their “appraisal” indicates no disagreement of substance with any of the Task Force's policy recommendations. and their tangential quibbles shrink when their content and context is understood.