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.