HOUSE APPROVES LEGISLATION ON ORGAN TRANSPLANT POLICY

(Washington) - Taking on an issue that means life or death to transplant patients, the House voted Tuesday to block a Clinton administration effort to move more hearts, livers and kidneys to those who are closest to death.

The legislation would strip the Department of Health and Human Services of its power to set transplant policy and comes after years of tension between HHS and the United Network for Organ Sharing, the private firm that has long run the transplant system under a government contract.

The House approved the measure, 275-147, shy of the 290 votes needed to override a promised presidential veto. By voice vote, it agreed to include an amendment that overtly kills HHS regulations already in place that direct more organs to the sickest patients -- even if they live far from the donor.

The legislation also 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.

The Senate has not yet acted on the issue, and both sides were hoping for a resolution there. Sens. Bill Frist, R-Tenn., and Edward Kennedy, D-Mass., had planned to introduce compromise legislation Wednesday that would give an expert commission power to mediate disputes. But the pair had not yet reached agreement, and Frist prepared to introduce the legislation on his own.

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, and 68,530 people are waiting for transplants today.

The legislation would give the transplant network total 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 will siphon away locally donated organs to other centers, jeopardizing their programs. They also argue that HHS has no right to write the rules, calling its effort to direct policy a "power grab."

"Is this bureaucracy up here equipped to make these decisions?" asked Rep. Michael Bilirakis, R-Fla., the bill's chief sponsor. "Do we want politics determining life and death matters? I think not."

Supporters of the current system also argue that states would have little incentive to encourage organ donation if the organs were being shipped to other states.

"If the fruits of your labor are going to be sent to another part of this country, that increases the chances that you won't work as hard," said Democratic Rep. Thomas Barrett of Wisconsin, where donation rates are high and the state has sued HHS to stop the new transplant regulations.

Congress has intervened in this emotional battle before, keeping the HHS regulations on hold for nearly two years.

In the meantime, Congress ordered the Institute of Medicine to study the system. In its report, the institute recommended that HHS assert more oversight over the transplant system. It also backed up the core of the HHS regulation, recommending that the geographic barriers be broken down.

Opponents of the legislation repeatedly cited that report as they argued that Congress should not strip the HHS of its authority.

The Justice Department has said giving control over legally enforceable policy to a private group may be unconstitutional.

Opponents also object to provisions that limit the amount of data about hospital performance that must be made public and make it difficult for the HHS to choose an alternate contractor to run the system.

The HHS regulations took effect last month, and the transplant network is now working on a new policy for distribution of livers, which have engendered the greatest controversy.

The transplant world has been consumed by the intense argument over distribution policy for two years. Shalala said she hopes the Senate will find a compromise.

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