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The Public Administration of Organ Allocation: Maintaining the Public – Private Partnership

PAM, Vol. 7 No. 3, (2002)

We examine the public administration of the Organ Procurement
and Transplantation Network (OPTN), established by Congress to oversee
organ rationing. In specific we examine the controversy over who has the
final say on organ allocation policy. Generated by increasing demand of
organs and apparent geographical inequities in waiting lists, the
controversy has pitted the U. S. Department of Health and Human Services
(DHHS) against the United Network for Organ Sharing (UNOS), the
private contractor operating the OPTN. Based on a case study of DHHS’s
efforts to promulgate an administrative rule regulating organ allocation,
we describe the dynamics of policy making and the political arena. UNOS
has claimed that policy making is best left with the private sector. We
conclude that the public is well-served by maintaining a strong role for

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