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81   Legislation on Transplants
     Should Begin With Specifics
     The Washington Post      Saturday, January 20, 1968

     The dramatic experiment in heart transplantation are only one episode
in the application of new biomedical techniques to human problems.  It
is perhaps regrettable that public interest has such an all-or none
character.  For a few days, the fate of the heart patients will 
dominate the headlines and then be forgotten while the hard work of
research on heart physiology and graft rejection goes on.

     These attempts at transplantation are experiments that must be
done even at the great risk they entail at this time.  The attempts
have been performed by surgeons well trained and equipped to analyze
their patients' responses and to further our knowledge of the 
conditions  under which the heart can be transplanted and effectively 
function.

     It will necessarily be some time before heart transplantation can
be justified as a lifesaving measure in its own right.  We should 
stand ready to condemn any trials that do not advance the research
frontier, that are motivated by the momentary public attention they
elicit.

     The surgical procedures for transplanting hearts have been 
practiced for some time in animals.  It is then no coincidence that 
several surgeons have almost simultaneously started such experiments 
with human subjects.  The main hindrance was the uncertainty of public 
reaction to such trials.

     While Dr. Bernard's first case had an unfortunate outcome, the
depth of news coverage undoubtedly contributed to a wide public 
understanding of the Washkansky case and its hazards, and helped to give
other responsible investigators the confidence to proceed.

     The episode has also awakened legislators to uncertainties and
ambiguities of existing law relating to organ transplants.  This
subject is mainly under the jurisdiction of the states and consistency
among them is obviously essential.  There must also be national 
concern about interstate movements of organs for transplant (whether
still implanted in a person or in a portable tissue bank), to 
operations on Federal territory and in the armed services, and to the 
involvement of foreign nationals.

     Sen. Walter F. Mondale (D. Minn.) has proposed the establishment
of a National Commission on the Ethical and Social Implications of
Health Science Research and Development.  It would "study the meaning
of health science research and development for this nation and the
world, explore its moral and ethical implications and formulate
ethical guidelines for its implication and make recommendations to the
President and the Congress for actions to assure that our social 
policies reflect and influence our technological advances."

     This perception of the importance of biological discovery for
human welfare is utterly commendable.  My criticisms of the proposal
have to do only with its huge scope.

     The issues mentioned by Sen. Mondale touch upon every aspect of
national action: foreign aid, the Asian war, our urban and racial 
conflicts, education, specific issues of medical care--in effect, every-
thing from birth to death.  What commission could give a conclusive
report on so many contentious issues?

     Congress is itself the most representative body for such a 
function.  It should of course demand expert advice on specific, 
pressing questions within its legislative competence.  On the other 
hand, we may doubt whether a creation of congress should be dignified
with the task of setting moral and ethical prescriptions as
distinguished from legal ones.  For example, how would it deal with
abortion and contraception as moral issues?

     Instead of tackling so many issues at once, why not concentrate
on the one most immediately at hand and investigate  what Federal
legislation might lead to the most orderly development of a rational,
socially fruitful use of organ transplantation? The conventional
mechanism of House and Senate committee hearings might serve just as
well as a special commission to attract public interest and present a
variety of sometimes irreconcilable viewpoints.

     Meanwhile, Sen. Mondale's broader proposal deserves careful
consideration for a frame of reference from which to plan further
advances.

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