ORGAN ALLOCATION: New Rules Could Stall Final Budget Deal

      Dissent over last week's deal authorizing the implementation of new organ transplant rules is threatening to derail negotiations for the $315 billion Labor-HHS spending bill, as well as other legislation, CongressDaily/A.M. reports (Rovner, 11/17). The House Commerce Committee already has approved a bill reauthorizing the National Organ Transplant Act, which would "effectively overturn" the new regulations, and Chair Tom Bliley (R-VA), whose Richmond district is home to UNOS, which opposes the change, is searching for a "legislative vehicle" to which he can attach the measure. In addition, Bliley is sitting on legislation that would reauthorize the Agency for Health Care Policy, which studies health policy issues, and would provide $40 million for pediatric teaching programs (Rovner, CongressDaily/A.M., 11/16). The move is an effort to exert pressure on Senate Health, Education, Labor and Pensions Public Health subcommittee Chair Bill Frist (R-TN), who sponsored the Senate version of AHCPR, to postpone the new organ transplant rules. Meanwhile, Sen. Jeff Sessions (R-AL) vowed to pool support for his Senate measure aimed at stopping the rules' implementation. "We as Republicans cannot allow Secretary Donna Shalala, an unelected bureaucrat to do an end run on Congress. As a member of the Senate's ... public health subcommittee, I believe that we should control the authority to formulate policy as it pertains to organ transplants," he wrote in a letter to Sen. Majority leader Trent Lott (R-MS)(cite>CongressDaily/A.M., 11/17). Charles Fiske, director of the National Transplant Action Committee was "furious" at the opposition movement, contending, "It seems as if Mr. Bliley and others were just not satisfied with the answer they got back from the Institute of Medicine report, and they are now willing to go to any lengths to have the regulations killed. It just angers me that someone would go to those lengths to protect what is essentially a constituent interest." But Bliley spokesperson Steve Schmidt said that the representative "understands the issue better because of his district," adding, "We believe strongly that patients should not have to deteriorate to the brink of death before being eligible for transplant." The Congressmen's "last-ditch" efforts, however, may be in vain, as House Speaker Dennis Hastert (R-IL) has already said he would back the Clinton Administration on the issue (AP/Las Vegas Sun, 11/17).

A Wrench in Budget Talks?
      The New York Times reports that "until the remaining bills are filed on the floor of the House, any member of Congress has the power to seek to add something to them," which means opposition to the transplant rules could drag out budget negotiations even longer. According to the Times House Republicans and Democrats hope to strike a deal today, condense the remaining five budget bills into one package and present them for a House and Senate vote. But GOP demands for a .42% across-the-board spending cut totaling $7 billion remains a sticking point. Nevertheless, Majority Whip Tom Delay (R-TX) said, "We're very, very close" (Weiner, 11/17).

Rooting for Change
      A Pittsburgh Post-Gazette editorial today lauds last week's deal, which allows regulations mandating that the sickest patients receive organs first to take effect. The old system of organ allocation, based on geography, "is not only unfair, with people in some parts of the country waiting years and in others only weeks, but it also is an inefficient use of these scarcest of medical resources," the editors write. They warn, however, that proponents of the changes must remain vigilant to prevent a Congressional override of the new rules, concluding, "Those who favor a much broader distribution of organs must not let down their guard and count the battle won. And advocates in a position of some power, like Pennsylvania Sen. Arlen Specter, must be as committed as the administration is to see that justice prevails" (11/17).