WASHINGTON -- A day after the House came down squarely against the Clinton administration's effort to assure that more donated organs go to the sickest transplant patients, the fight is shifting to the Senate, where a compromise is brewing.
Sen. Bill Frist, R-Tenn., who was a heart transplant surgeon before he entered politics, planned to introduce legislation Wednesday that tries to balance the interests of the private company that runs the transplant system under a government contract and the Department of Health and Human Services, which wants to make changes.At issue is which side should have the power to write rules governing the distribution of organs and what those rules should be.
HHS and its allies argue that this is an issue of public policy that should be decided by federal officials who are accountable to taxpayers, and it has proposed replacing the current geographically based distribution system with one that would get organs to the neediest patients first.
The United Network for Organ Sharing and its supporters argue that this is a medical question that should be decided by the transplant professionals who make up the network. The network's distribution system is designed so that local patients get first crack at donated organs.
On Tuesday the House backed the network in a 275-147 vote that would strip HHS of its authority to set policy and overturn its proposed new rules.
"The federal government is simply not equipped to make these decisions," said Rep. Tom Bliley, R-Va., the House Commerce Committee chairman.
The Clinton administration promised a veto should his bill reach the president's desk. The House bill did not attract the 290 votes that would be needed to overturn a veto.
HHS Secretary Donna Shalala accused the House of ignoring the findings of a congressionally ordered study of the organ transplant system. But she predicted that a better bill would emerge eventually.
"In the months ahead, this vote will be seen for what it is -- an unfortunate footnote to larger good-faith efforts that are under way to achieve the best organ transplant system possible," she said in a statement.
Shalala and others are now looking to the Senate.
The Frist bill would allow the transplant network to write allocation policy. But if HHS objected to the network's actions and the two sides could not find a compromise, the matter would be settled by an independent commission. The commission would comprise people appointed by both sides, plus experts picked by the Institute of Medicine, which is part of the National Academy of Sciences.
Frist had hoped to co-sponsor the bill with Sen. Edward Kennedy, D-Mass., a leader among Senate Democrats on health care issues. But as of late Tuesday, Kennedy had not agreed to sign on.
The two offices were still talking, but Frist planned to move forward without Kennedy if necessary.
The basic problem is supply and demand. Only about half of families asked to donate organs say yes, and many families are never asked. Meanwhile, nearly 5,000 people die each year waiting for organ transplants; 68,530 people are waiting for transplants today.
The legislation passed by the House encourages organ donation, something all sides support. It calls for financial assistance for living donors who give away a kidney or part of a liver, and offers grants for states to encourage donation.
More controversially, it gives the transplant network complete control over the rules governing how to distribute more than 20,000 organs that are donated each year.
Under the network's system, patients who live in the same area as donors have first chance at organs, even if a sicker patient lives just outside the border. The Clinton administration wants to eliminate those geographic barriers, saying someone's chance at life should not be dictated by where they live.
"Healthy people are getting organs before they need them and the very sick are not getting organs before they die," said Rep. John Dingell, D-Mich.
The transplant network and many transplant centers -- particularly smaller hospitals -- fear that change would siphon away locally donated organs to other centers, jeopardizing their programs.
Supporters of the current system also argue that states would have little incentive to encourage organ donation if the organs were being shipped elsewhere.
On the Net: United Network for Organ Sharing: www.unos.org
HHS Division of Transplantation: www.hrsa.gov/osp/dot