Organ Donation Clarification Act of 2020

I 116TH CONGRESS 2D SESSION H. R. 7900 To amend the National Organ Transplant Act to clarify the definition of valuable consideration, to clarify that pilot programs that honor and promote organ donation do not violate that Act, and for other purposes. IN THE HOUSE OF REPRESENTATIVES JULY 31, 2020 Mr. CARTWRIGHT introduced the following bill; which was referred to the Committee on Energy and Commerce A BILL To amend the National Organ Transplant Act to clarify the definition of valuable consideration, to clarify that pilot programs that honor and promote organ donation do not violate that Act, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Organ Donation Clari- 4 fication Act of 2020’’. 5 SEC. 2. FINDINGS. 6 Congress finds the following: 7 VerDate Sep 11 2014 04:13 Aug 18, 2020 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H7900.IH H7900 kjohnson on DSK79L0C42PROD with BILLS 2 •HR 7900 IH (1) As of June 2020, 111,000 people await an 1 organ transplant, with 93,000 of those people wait- 2 ing for a kidney, and average wait times are ap- 3 proaching five years for a kidney, with nearly twice 4 as many people being added to the waiting lists as 5 getting a transplant. 6 (2) Of the roughly two million Americans who 7 die annually, only 10,500 to 13,800, representing 8 less than one percent of all deaths each year, possess 9 major organs healthy enough for transplanting. 10 (3) On average, 22 people a day died while 11 waiting for an organ in 2019, with the majority of 12 those people waiting for a kidney. 13 (4) In 2019, approximately 4,200 people were 14 removed from kidney waiting lists and approximately 15 1,700 from liver, heart, and lungs waiting lists be- 16 cause they became permanently too sick to receive a 17 transplant. 18 (5) Ninety percent of dialysis patients are not 19 employed because dialysis requires multiple treat- 20 ments per week which last several hours and leave 21 patients drained, thus creating a huge financial bur- 22 den on the patients, their families, and the govern- 23 ment; moreover, lost tax revenue from these individ- 24 uals is not included in the cost estimates above, and 25 VerDate Sep 11 2014 04:13 Aug 18, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H7900.IH H7900 kjohnson on DSK79L0C42PROD with BILLS 3 •HR 7900 IH which can help lead to as few as 10 percent of dialy- 1 sis patients being employed. 2 (6) A patient receiving a kidney transplant, and 3 thus no longer needing dialysis, can enjoy a much 4 higher quality of life for another 10–15 years on av- 5 erage. 6 (7) As medical advances extend people’s lives on 7 dialysis, the number of patients on dialysis will in- 8 crease significantly, as will the costs for individuals 9 and the Federal Government. 10 (8) Roughly seven percent of the Medicare 11 budget goes to the End Stage Renal Disease Pro- 12 gram, with dialysis costing Medicare over $90,000 13 per patient per year, as Federal law dictates that 14 Medicare will cover dialysis for everyone who has 15 made minimal Social Security tax payments. 16 (9) A kidney transplant pays for itself in less 17 than two years, with each transplant saving an aver- 18 age of over $700,000 in medical costs over a 10-year 19 period, 85 percent of which is savings to the tax- 20 payers. 21 (10) Experts project that if the supply of trans- 22 plant kidneys could be increased to meet the de- 23 mand, taxpayers would save more than 24 $12,000,000,000 per year in medical costs. 25 VerDate Sep 11 2014 04:13 Aug 18, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H7900.IH H7900 kjohnson on DSK79L0C42PROD with BILLS 4 •HR 7900 IH (11) The World Health Organization estimates 1 that 10 percent of all transplants take place on the 2 international black market, the last choice for des- 3 perate patients facing an alternative of death, how- 4 ever recipients often receive infected kidneys and 5 suffer poor health outcomes and donors are often 6 victimized. 7 (12) Present policy on domestic donation has 8 never been subject to studies or pilots to determine 9 effectiveness in increasing the availability of donated 10 organs and the effectiveness of safeguards that pre- 11 vent coercion or exploitation, precludes all but altru- 12 istic donation, prohibiting any form of incentive or 13 benefit for donors. 14 (13) In 2010, Israel implemented sweeping 15 changes to its national organ donation program in- 16 cluding reducing financial burdens on donors, giving 17 future transplantation priority to registered organ 18 donors and their families, and promoting donation 19 by reimbursing the donor’s medical costs, 40 days of 20 lost wages, and five years of medical and life insur- 21 ance costs, and as a result saw organ donation ap- 22 proximately triple over a 10-year period. 23 (14) Experts are arriving at a consensus that 24 trials are necessary to find new methods of pro- 25 VerDate Sep 11 2014 04:13 Aug 18, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H7900.IH H7900 kjohnson on DSK79L0C42PROD with BILLS 5 •HR 7900 IH moting additional organ donation which will save 1 lives and reduce organ trafficking. 2 SEC. 3. CLARIFICATION OF CERTAIN PROVISIONS OF THE 3 NATIONAL ORGAN TRANSPLANT ACT. 4 (a) RELATION TO OTHER LAWS.—Section 301 of the 5 National Organ Transplant Act (42 U.S.C. 274e) is 6 amended by adding at the end the following: 7 ‘‘(d) RELATION TO OTHER LAWS.— 8 ‘‘(1) GOVERNMENTS ENCOURAGING ORGAN DO- 9 NATION.—This section shall not— 10 ‘‘(A) apply to actions taken by the Govern- 11 ment of the United States or any State, terri- 12 tory, tribe, or local government of the United 13 States to carry out a covered pilot program; or 14 ‘‘(B) prohibit acceptance of any noncash 15 benefits provided by the pilot program under 16 subparagraph (A). 17 ‘‘(2) NO PROHIBITION ON OTHER BENEFITS 18 PROGRAMS.—Nothing in this subsection shall be con- 19 strued to prohibit actions, other than actions de- 20 scribed in this section, taken by any State, territory, 21 tribe, or unit of local government in the United 22 States to provide benefits for human organ donation. 23 ‘‘(3) COVERED PILOT PROGRAM.—For purposes 24 of this subsection— 25 VerDate Sep 11 2014 04:13 Aug 18, 2020 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H7900.IH H7900 kjohnson on DSK79L0C42PROD with BILLS 6 •HR 7900 IH ‘‘(A) the term ‘covered pilot program’ 1 means a pilot program approved by the Sec- 2 retary of Health and Human Services, subject 3 to an ethical review board process, with a term 4 of not more than 5 fiscal years, for the purpose 5 of measuring the effect of removing disincen- 6 tives or providing a noncash benefit that may 7 increase the organ pool. Distributions of organs 8 from deceased donors under the pilot program 9 shall be conducted only through the Organ Pro- 10 curement and Transplantation Network at a 11 transplant center approved by the United Net- 12 work for Organ Sharing or any other entity 13 designated by the Secretary of Health and 14 Human Services; and 15 ‘‘(B) the term ‘noncash benefit’ means any 16 benefit or thing of value received by an organ 17 donor that is impossible to sell, trade, or other- 18 wise transfer to another individual.’’. 19 (b) VALUABLE CONSIDERATION.—Section 301(c)(2) 20 of the National Organ Transplant Act (42 U.S.C. 21 274e(c)(2)) is amended to read as follows: 22 ‘‘(2) The term ‘valuable consideration’ does not 23 include the following: 24 VerDate Sep 11 2014 04:13 Aug 18, 2020 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H7900.IH H7900 kjohnson on DSK79L0C42PROD with BILLS 7 •HR 7900 IH ‘‘(A) Reasonable payments associated with 1 the removal, transportation, implantation, proc- 2 essing, preservation, quality control, and stor- 3 age of a human organ. 4 ‘‘(B) Reimbursement for travel, lodging, 5 food during travel, and other logistical expenses 6 related to donation. 7 ‘‘(C) Provision of advanced payments or 8 reimbursement for dependent care needs for 9 pre-transplant appointments in addition to dur- 10 ing the period of donation and post-transplant 11 follow-up care related to the donation for up to 12 a 10-year period. 13 ‘‘(D) Reimbursement for lost wages related 14 to donation. 15 ‘‘(E) Medical expenses related to donation 16 and all related follow-up care including prevent- 17 ative follow-up care and medication for up to a 18 10-year period. 19 ‘‘(F) Paperwork or legal costs related to 20 donation. 21 ‘‘(G) Any term life insurance policy against 22 the risk of death or disability as a result of do- 23 nating an organ or the longer-term health ef- 24 fects of having donated an organ, that— 25 VerDate Sep 11 2014 04:13 Aug 18, 2020 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H7900.IH H7900 kjohnson on DSK79L0C42PROD with BILLS 8 •HR 7900 IH ‘‘(i) in the case of a life insurance pol- 1 icy, provides for payments in amounts less 2 than $2,000,000, adjusted annually for in- 3 flation; and 4 ‘‘(ii) in the case of a disability insur- 5 ance policy, provides for payments equal to 6 or less than the reasonable earnings expec- 7 tations of the donor.’’. 8 Æ VerDate Sep 11 2014 04:13 Aug 18, 2020 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6301 E:\BILLS\H7900.IH H7900 kjohnson on DSK79L0C42PROD with BILLS