ORGAN DONATION: Cmte. Blocks White House Revisions

      The United Network for Organ Sharing yesterday won the first skirmish in its battle with HHS for control of the nation's organ transplant network. The House Commerce Committee approved reauthorization of the National Organ Transplant Act of 1984, which blocks proposals from White House administrators to revise the nation's organ allocation system. The measure also cedes more authority to UNOS, which currently operates the organ transplant network under HHS. Commerce health and environment subcommittee Chair Michael Bilirakis (R-FL) said, "This recognizes the decisions about organ transplants and allocation are best left to the medical community, as Congress intended." Rep. Greg Ganske (R-IA), a physician, agreed with Bilirakis, saying, "HHS is simply not qualified to dictate our nation's organ allocation policy." Others point the finger at UNOS, "which has been accused of trying to protect the economic interests of smaller transplant centers at the expense of patients at larger centers." Rep. John Dingell (D-MI), the ranking committee member, said, "This is an outrageous piece of legislation. This bill seems to sanctify the idea that some functions are just too important for government oversight." HHS Secretary Donna Shalala threatened to recommend a veto if the bill passes, saying, "We have serious concerns that the bill would preserve existing inequities in the organ transplantation system and could result in potential harm to patients." Opponents of the bill have broached the idea of the bill's constitutionality, because "it delegates government powers to a private entity." Two amendments -- one restoring HHS' oversight and one barring "UNOS from using patient fees to lobby Congress or other elected officials" -- were defeated.

Oregon's Pain
      In related news, the committee also approved the Pain Relief Promotion Act, sponsored by Rep. Henry Hyde (R-IL), that prohibits using drugs on the government's list of controlled substances "for the purpose of causing death or assisting another person in causing death." CongressDaily/A.M. reports that the bill "would effectively overturn Oregon's first- in-the-nation assisted suicide law." Changes made to a 1998 version of the law -- including provisions promoting use of "palliative" care for patients in "intractable pain" and noting that controlled substance use to alleviate pain "is consistent with public health and safety, even if the use of such a substance may increase the risk of death" -- appear to have won the support of some in the medical community. Rep. Bart Stupak (D-MI) said the bill "gives physicians the ability to aggressively manage pain" (Rovner, 10/14). All five of Oregon's representatives oppose the bill. Rep. Darlene Hooley (D-OR) said, "'It's going to be a David-Goliath type of fight' with Oregon as the underdog," adding, "It's tough to go up against the Judiciary chair. ... But we still have a shot over here." Sen. Ron Wyden (D-OR) has vowed to fight the bill, "even if that means stalling the work of Congress for days with a filibuster." Testifying before the Senate Health, Education, Labor and Pensions Committee, Wyden said that the bill "puts the intrusive nose of the government into the doctor-patient relationship once more, this time in the extraordinarily sensitive moment of terminal illness" (AP/Oregonian, 10/14). CongressDaily/A.M. reports that others oppose the bill because they question the authority of Drug Enforcement Agency agents in "trying to determine if drugs are being prescribed to control pain or to end a life." Rep. Henry Waxman (D-CA) said, "The mere possibility (of a DEA investigation) would be enough to deter the treating of pain" (Rovner, 10/14).