[Congressional Record Volume 146, Number 41 (Wednesday, April 5, 2000)]
[Senate]
[Pages S2228-S2229]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                   NATIONAL ORGAN TRANSPLANTATION ACT

  Mr. DURBIN. Mr. President, I ask unanimous consent that a letter 
dated April 5, 2000, addressed to Senators Lott and Daschle, be printed 
in the Record.
  There being no objection, the letter was ordered to be printed in the 
Record, as follows:

       We are writing to lodge our strong objection to 
     consideration of H.R. 2418 by the Senate. This bill would 
     reauthorize the National Organ Transplantation Act (NOTA) in 
     a manner that would adversely affect patients in many states 
     including our own, who are desperately in need of organ 
     transplants.
       Every year, over 4,000 people die waiting for an organ 
     transplant. The organ allocation policy established by the 
     Organ Procurement and Transplantation Network (OPTN) has been 
     inequitable. Patients with similar severities of illness are 
     treated differently, depending on where they live or at which 
     transplant center they are listed. Patients in some parts of 
     the country wait much longer than patients in other regions, 
     who have the same level of illness. So for some, the chance 
     of dying before they actually receive a transplant is much 
     higher than for others. Over the last 3 years, 97 people died 
     while waiting for an organ transplant at the University of 
     Chicago, 187 died while

[[Page S2229]]

     waiting at the University of Pittsburgh, 99 died while 
     waiting at Mt. Sinai, NY, and 46 children died while waiting 
     for an organ at the Children's Hospital in Pittsburgh.
       Additional problems occur when hospitals provide large 
     numbers of life-saving transplants to out-of-state patients. 
     Maryland hospitals, for instance, are required to pay back 
     United Network for Organ Sharing (UNOS) with the total number 
     of kidneys used in transplant operations, even though 40 
     percent of those transplant are performed on patients from 
     other states. This means that states with small populations 
     and centers of excellence in transplantation more easily 
     build up a so-called ``kidney debt.'' A ``payback'' 
     requirement also applies to livers between some Organ 
     Procurement Organizations (OPOs) or within certain OPOs. 
     Without greater regional sharing of organs, such policies 
     result in longer than the national average wait times and 
     possible sanctions by UNOS, merely because a state provides 
     life-savings services to non-residents.
       To eliminate these inequities, the Department of Health and 
     Human Services (HHS) issued regulations, which became 
     effective March 16th, that establish a framework for organ 
     allocation policies to be developed by the network. The 
     policies will be based on sound medical judgment and will be 
     fairer for all patients, irrespective of where they live.
       Regrettably, H.R. 2418 would take us backward and undermine 
     current efforts make the system more equitable. The bill 
     delegates current government authority to a private entity 
     without appropriate standards of Federal review. The bill 
     denies HHS any role in overseeing organ allocation and 
     promoting practices that are in the best interest of the 
     entire public health. The congressionally mandated study by 
     the Institute of Medicine clearly stated that such a role for 
     HHS was both necessary and appropriate. Instead, the bill 
     grants extraordinary powers to a private sector entity to 
     select and approve the Federal controller that manages the 
     OPTN. The manner of such selection does not appear to be 
     consistent with existing principles of the Federal 
     acquisition process, which promote full and open competition 
     in awarding Federal contracts. Furthermore, the bill would 
     not incorporate the Institute of Medicine's recommendation of 
     standardization of patient listing practices and broader 
     sharing of organs.
       It is our hope that we can work with the committee of 
     jurisdiction here in the Senate, the Health, Education, Labor 
     and Pension Committee, to forge in an alternative 
     reauthorization bill. It is our understanding that Senators 
     Frist and Kennedy are currently working on a bill that would 
     be more in keeping with the IOM's recommendations. We ask 
     that this bill not disrupt the new HHS regulations.
       Because of our strong objections to H.R. 2418, we request 
     that we be notified and consulted before any unanimous 
     consent agreement is sought for any legislation that seeks to 
     reauthorize the National Organ Transplant Act, to ensure our 
     ability to exercise our rights in the shaping of this 
     important legislation.
       Thank you for your consideration in this matter.
           Sincerely,
     Richard J. Durbin,
     Bob Kerrey,
     Rick Santorum,
     Barbara A. Mikulski,
     Peter G. Fitzgerald,
     Chuck Hagel,
     Arlen Specter,
     Paul S. Sarbanes,
     Charles E. Schumer.

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