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A Transplant "Compromise" - Washington Post Editorial - April 19.

"The vicious politics of organ transplants, which earlier produced a thoroughly discreditable bill in the House stripping the federal government of any authority to regulate this scarce and lifesaving resource, have moderated somewhat in the Senate. A bill sponsored by Sen. Bill First emerged from committee after intensive negotiations with Health and Human Services Secretary Donna Shalala and Sen. Edward Kennedy. It's an ostensible compromise between supporters of the fairer organ distribution system backed by HHS, which the House bill would block, and supporters of the existing system, which is based on geography and run by a private contractor. But it's not clear that this 'compromise' can make it to enactment, or if it does, that it will have the teeth to impose real change on the transplant system's current inequities any time soon. The basic dispute remains whether organs should be distributed with preference for local recipients-the system-or whether the contractor that developed and administers that system, the United Network for Organ Sharing, should be required to change it so that sicker patients have a shot at organs wherever they live.

The organ network has fought fiercely against any change, and it has lots of allies, mainly in states that 'harvest' a lot of organs and don't want to share them. A system weighted less toward location would result in those centers shipping more of 'their' organs to large hospital centers where patients in need of immediate transplant tend to cluster.

The Senate compromise doesn't address who should get organs; rather, it would send disagreements between HHS and the organ network to an 'appeals board' picked by transplant professionals, the independent Institute of Medicine (which is on record of favoring changes) and the government. How long this process would delay any actual changes in transplant practice is anyone's guess, but it could be years-besides needlessly diluting the legal authority to set organ policy that HHS quite properly claims to have already. That raises the question of why the administration has signed on. Nor is it obvious that the Kennedy-Frist compromise can avoid further watering down; Sen. Russell Feingold of Wisconsin has blocked even this bill from quick consideration, saying he has 'misgivings' about the appeals board's makeup. Wisconsin just happens to be suing to block the HHS rule that would allow 'its' organs to be sent out of state.

That rule, which went into effect March 16, was supposed to set changers in motion, with the government and the organ network cooperating to improve distribution. The new round of machinations slows that process to a crawl. Meanwhile, patients awaiting transplants die at the rate of 10 a day. Their lives are being squandered for the purest and pettiest of self-interested and political reasons-this on an issue that you'd thing would strike at least some players, somewhere, as transcending parochial concerns."
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Publication:Transplant News
Date:Apr 28, 2000
Words:471
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