The office where William F. Berry has just hung his Senior Executive Service (charter member) plaque is pure government issue, down to the surplus-property chairs in the anteroom. But then Berry's mandate as director of the two-week-old Office of Organ Procurement and Transplantation is pure government-issue too: ambitious yet ambiguous.
For the next 33 months, Berry, who has made a career of taking offices apart and putting them together for the Health and Human Services Department, will be the point man of a congressionally inspired effort to triple the number of kidneys, hearts, livers, lungs and pancreases available for transplantation into patients whose organs are failing.
To aid him in this task, Berry will have a 25-member task force (to be appointed in the next six weeks by HHS Secretary Margaret M. Heckler) that Berry's office will help select and staff, $25 million in grants to give to nonprofit groups that obtain organs for transplantation, $2 million to form a network of these groups, and his ability to nudge, persuade, cajole or yell.
But there are things he lacks. A budget, for one. Congress authorized his office after the Labor-HHS appropriations bill was passed. A supplemental appropriation would cure that problem.
More importantly, Berry says he has no power to investigate or enforce the new ban on interstate sale of organs, nor does he have any direct say in the spending or withholding of the $70 million in Medicare funds HHS gives annually for kidney transplants. Kidney transplants (6,112 in the United States in 1983, according to HHS) vastly outnumber those of all other organs, including heart (about 175), lung (fewer than 40) and pancreas (under 50.)
Gruff and tidy, Berry is a manager's manager, an artist of the organizational-chart school. He speaks of "units," and "subunits," tracing them in the air with his hands. The pens, pencils and papers on his desk form neat right angles. He values precision. Give him a second to refer to his calendar, and he can tell you when he was informed of his new job -- "let's see . . . . I was called in at 1:30 on Friday, Nov. 8."
At the time, he was preparing to lecture a group of Indian Health Service officials on "one-minute managing" ("it's the latest thing in this business"). He had come to the Indian Health Service after some time spent reluctantly carrying out the Reagan administration attempts to dismantle some federally supported programs designed to control the cost of health care.
It was not a job he enjoyed. Mentioning it during a recent interview, Berry said, "I've been in a situation where I was put in a position to do a particular job that I thought was inappropriate."
Even while engaged in the unbureaucratic business of criticizing the current administration, Berry still chooses his words with the care of a career bureaucrat.
"This office is different in a couple of ways from anything I've previously been involved in," Berry said. "The first thing is, it's the most visible program I've ever been involved in."
In the past two years, several well-publicized cases have focused attention on the plight of patients needing organs that are in short supply. In one case, the appeal of Charles Fiske for a liver for his 11-month-old daughter Jamie was broadcast on a nationwide newscast. A Utah couple whose baby was killed in an auto accident volunteered to give Jamie Fiske their child's liver. Jamie celebrated her third birthday on Thanksgiving.
Since then, President Reagan made an appeal for a liver for another child, doctors in California transplanted a baboon's heart into a critically ill child known as Baby Fae, and last week surgeons in Louisville, for the second time in history, implanted an artificial heart into a patient.
"The second thing about this office," Berry continued, "is that it has by far and away the tightest deadlines for its product." In particular, he said, the deadlines of the new task force are tight. With one aide and one secretary at the moment, Berry must give Heckler his recommendations for individuals to serve on the task force in time for her to make appointments by mid-January.
The group, to be made up of doctors, representatives of organ procurement groups and members of the public as well as some top HHS officials, is to research and help provide answers to some questions Congress could not answer, including one key one: how valuable is the immunosuppressant drug cyclosporine, widely used to prevent transplant patient's bodies from rejecting the new organs, and how far should the government go in underwriting costs of what may be lifelong drug therapy?
A report on that question is to be sent to Congress in mid-August. "We're going to have to work with the chairman of the task force very carefully to keep things focused," Berry said. "We don't exercise control over the task force. But group dynamics can be difficult. We've got to do everything we can to get that product in."
Beyond the issue of cyclosporine, the task force must look into questions of equitable allotment of available organs, public and professional education about organ donation and the lack of insurance coverage for procedures still viewed as experimental.
Even if the task force was at work, Berry would still have to build the regulatory and legal infrastructure his office needs to perform its other functions. No grants can be given unless there are applications; no one can apply unless there's a formal "request for proposals;" no one can write a request for proposals unless there are grant regulations; and Berry as yet has no one to write those rules.
"The thing we need," he said, "is an appropriation." He wants to assemble a staff of 10 as soon as possible.
The grant program, which allows grants of up to $500,000 to organ procurement centers, can be used as a carrot to induce participation in a national network. "The main driving force for a hospital or private group to get on the network is that they will broaden their horizons," Berry said.
"For us, the incentive is to make as many organs available . . . as are available . . . . The potential payoff here is great, in terms of improving the quality of people's lives and actually saving lives."