House Rejects Transplant Organ Plan That Favors Sickest Patients Anywhere

The House on Tuesday rejected the Clinton administration’s controversial plan to offer transplant organs to the sickest patients first, regardless of where they live.

In a largely partisan 275-147 vote, the Republican-controlled House instead approved a measure that would return to a policy of distributing organs to medically eligible patients in a local area first, in order of need, before being offered regionally and then nationally.

To make that change, the House stripped the Department of Health and Human Services’ power to set transplant policy and returned control of organ distribution to the network that has run the program under a government contract since 1984, the United Network for Organ Sharing.

“Do we want the government determining life-and-death matters?” asked Rep. Michael Bilirakis (R-Fla.), sponsor of the legislation. “I think not.”

But Rep. John D. Dingell (D-Mich.) countered that, with UNOS in control, “healthy people are getting organs before they need them, and the very sick are not getting them before they die.”

Shalala Says House Ignores Patient Needs

HHS Secretary Donna Shalala reacted angrily to the vote, saying the House had “closed its eyes . . . to the goal of fairness and the needs of patients.” The House, she added, “has turned its back on the facts about our organ transplantation system.”

UNOS officials, however, applauded the House action, saying that it “goes a long way toward resolving the difficult and controversial issue of organ transplantation.”

The Clinton administration, questioning the constitutionality of stripping HHS authority over the issue, has threatened to veto the House bill.

Sens. Bill Frist (R-Tenn.), who is a transplant surgeon, and Edward M. Kennedy (D-Mass.) are trying to draft a compromise measure that they hope all parties can accept. It would give an expert panel the authority to intervene and resolve transplant policy disputes.

Members of the California delegation voted largely along party lines, with Republicans supporting the measure and Democrats opposing it. Only one Democrat, Rep. Robert T. Matsui of Sacramento, supported the bill, explaining that he felt “medical and ethical issues are better handled at the community level than by a national bureaucracy.”

During the 1990s, the nation started experiencing a severe shortage of organs as medical advances made transplantation increasingly more successful. According to medical estimates, 12 Americans die every day while waiting for an organ transplant. About 68,000 people are waiting at any given time, and about 17,000 organs are donated annually.

Responding to the dilemma created by more people vying for fewer organs, surgeons and organ procurement centers introduced more flexibility into determining which organs are usable, in some cases easing standards. With livers, the sharing of single organs among several patients was encouraged.

Clinton health officials, meanwhile, last year proposed putting illness ahead of geography in deciding who would receive transplants. That regulation became effective March 16.

The change provoked a highly emotional debate. Supporters of the new rules argued that they provided a more equitable process for the sickest patients, whose fate until then depended on their location. Opponents insisted that scarce organs could be wasted on patients who had little chance of survival and should go to those with the best prognosis.

In Wisconsin, where patients receive organs relatively quickly, the state filed a federal suit against HHS to try to halt the regulations; Louisiana and Texas have filed similar litigation. But the courts have not acted to block implementation of the rules.

Under the old system, Californians experienced a relatively short waiting period compared to the rest of the nation, according to UNOS. There are 11 transplant centers in the state, and Southern California “has excellent local procurement organizations,” one UNOS official said.

The contentious debate over distribution revolved around not only medical decision-making but also who would control these precious resources--the federal government or UNOS.

There has been “a monopoly over the handling of organs in this nation,” said Dingell. UNOS “seeks to be totally exempt of controls the federal government would impose on any other contractor.”

Lawmaker Sees a Power Grab

But Rep. Ernest J. Istook Jr. (R-Okla.) countered that the legislation “will stop a power grab by the administration, one of the most distasteful power grabs we’ve seen. Who says the federal government is in charge of everybody when we die?”

Shalala and opponents of the bill frequently cited an Institute of Medicine report issued last year that backed HHS’ oversight of the transplant system and urged an end to geographic barriers.

While UNOS has been working with federal health officials to implement the new policy, the organization has never favored the changes and supports lawmakers’ efforts to restore its decision-making.

UNOS officials said Tuesday that they would continue to work with lawmakers, particularly Kennedy, Frist and others in the Senate, “to pass a bill that meets the needs of patients awaiting lifesaving transplants.” It also pledged to cooperate with HHS “to improve organ allocation policy.”

Shalala, who called the House bill “a step backward,” predicted that in the months ahead, “this vote will be seen for what it is: an unfortunate footnote to the larger good-faith efforts that are underway to achieve the best organ-transplant system possible.”

In a provision supported by all sides, the House bill also encourages organ donation by providing financial assistance for living individuals who donate kidneys or parts of a liver and provides incentives in the form of grants to states to encourage such donations.