[Congressional Record Volume 144, Number 80 (Thursday, June 18, 1998)]
[Extensions of Remarks]
[Page E1164]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




  JOINT HEARING--SENATE LABOR AND HUMAN RESOURCES AND HOUSE COMMERCE 
                  COMMITTEE; ORGAN DONATION ALLOCATION

                                 ______
                                 

                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                        Thursday, June 18, 1998

  Mr. STARK. Mr. Speaker, I would like to commend Chairmen Jeffords and 
Bliley for conducting hearings on the problem of organ allocation. As 
they well known, organs have not been allocated in a fair way to 
benefit patients in the past and we are in a position now to take a 
stand for patients and for fairness.
  This is a simple issue of fairness and quality. If you are a patient 
in need of a transplant and you live in Tennessee, the average time you 
spend on the waiting list is about 21 days. If you live in my part of 
the country, the San Francisco Bay Area, the average waiting time for 
that same patient is over 300 days.
  In every part of the country, the Cleveland Plain Dealer reports that 
minority candidates wait longer than their white counterparts for 
available organs.
  Is this fair? When my good friend Congressman Moakley was diagnosed 
with hepatitis B and was in need for a liver transplant, his doctors 
told him to leave Boston and move to Virginia to increase his chances 
of obtaining a liver.
  Fairness is half of this fight. Quality is the other. There is a lot 
of money to be made in organ transplants. Too many centers have been 
opened to increase the prestige and the profits of a local hospital--
and not because they do a good job. In fact, in general the lower 
volume small transplant centers have poorer outcomes than the high 
volume transplant centers. The fact is, having a transplant center has 
become the equivalent of health pork. Many of these centers are like 
the excess projects in the recently-passed highway bill: centers 
without a justification. But unlike highway pork, these centers often 
end up killing patients because they do not do as good a job as the 
high volume centers. I really think it is immoral for centers who have 
a lower success rate than the high volume centers to be fighting the 
Department's regulation. Their actions are a disgrace to the 
Hippocractic Oath.
  The proliferation of poor quality transplant centers not only wastes 
lives, it wastes money. The United States has 289 hospitals doing 
transplants--and that is an enormous commitment of capital. I have read 
that a hospital has to invest about $10 million to be able to do heart 
transplants.
  These proliferating costs are part of what drives health inflation in 
the United Sates and part of what places such huge budget pressures on 
Medicare. Concentrating transplants in fewer, high-quality, life-saving 
centers would allow us to save hundreds of millions of dollars in the 
years to come. The Department's regulation gives us the potential to 
focus on Centers of Excellence where we not only save lives, but can 
obtain economies of scale necessary to preserve the Medicare program.
  If my colleagues are serious about putting patients first, what is so 
onerous about a system that proposes to base transplant decisions on 
common medical criteria on a medical need list--not geography, not 
income, not even levels of insurance coverage--just pure professional 
medical opinion and medical need.
  This hearing is about putting patients first--not putting transplant 
bureaucracies first. I can think of no better way to put patients first 
than to make the system fair for all. I urge the Committees to support 
the Department's regulations.

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