Armed with a supportive report by an independent scientific panel, the Clinton administration is asking Congress to allow its policy on organ transplantation to take effect.
"I hope you will read the report," Health and Human Services Secretary Donna Shalala wrote in a letter sent to every member of Congress. "It is thoughtful, balanced and clear."
The report by the Institute of Medicine, an arm of the National Academy of Sciences that frequently advises the government, essentially supports the administration's approach to allocation of scarce organs for transplant. For its part, the other side wrote its own letter to Congress, focusing on a few areas where the report supports its concerns.
"The Department of Health and Human Services should go back to the drawing board with the transplant community and agree on new policies that will benefit all patients," wrote Dr. William Payne, president of the United Network for Organ Sharing, which runs the nation's transplant system under an HHS contract and strongly opposes the HHS policy.
The essential problem is supply and demand: Nearly 21,000 transplants were performed last year, but more than 4,800 people died waiting for a new organ.
At issue is how to distribute donated organs among some 65,000 patients now waiting for transplants.
The transplant network and much of the transplant community support the current system, which relies on geography. Organs are offered locally first, then regionally and then nationally _ meaning a relatively healthy patient who is located close to the organ donor often gets offered an organ before a sicker patient elsewhere.
Last year, the HHS issued regulations directing the network to remake its system and give organs to the sickest patients first.
The network objected _ both to a new system and to HHS telling it what to do _ and lobbied Congress for a change. Congress put the rule on hold for a year and asked the Institute of Medicine to study the issue.
In the meantime, the HHS has been negotiating with transplant surgeons and hospitals and plans to issue a revised version of its regulations within weeks. The network agrees the discussions have been productive.
A moratorium on the rule's implementation expires Oct. 21, and the HHS is asking Congress to let it take effect.
The report recommends establishing larger areas for sharing livers, the organ that has generated the most controversy.