REPORT TITLE:
Anatomical Gifts


DESCRIPTION:
Creates a funding mechanism to educate the public about organ and
tissue donation.  Requires hospitals to report the suitability of
patients for organ and tissue donation.  (HB547 CD1)

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                        547
HOUSE OF REPRESENTATIVES                H.B. NO.           H.D. 3
TWENTIETH LEGISLATURE, 1999                                S.D. 2
STATE OF HAWAII                                            C.D. 1
                                                             
________________________________________________________________
________________________________________________________________


                   A  BILL  FOR  AN  ACT

RELATING TO ANATOMICAL GIFTS.



BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

 1      SECTION 1.  The legislature finds that there exists in the
 
 2 State a shortage of organ and tissue donors to provide the organs
 
 3 and tissues that could save lives or enhance the quality of life
 
 4 for many persons.  There are many more patients on the waiting
 
 5 list for a kidney, liver, heart, lung, or other solid organs than
 
 6 there are donated organs.  As a result, many patients die before
 
 7 they can be given a second chance at life.
 
 8      The legislature further finds that particular difficulties
 
 9 exist in making members of various minority groups aware of the
 
10 need for anatomical gifts.  For various reasons minorities appear
 
11 to be at increased risk to suffer illnesses, such as diabetes,
 
12 which destroy healthy organs and require replacement.  The
 
13 chances of finding a good organ match is increased if the donor
 
14 is of the same ethnic group as the transplant recipient.
 
15 Minority ethnic groups must be educated in the great need among
 
16 their own people for anatomical gifts.  The legislature finds
 
17 that more education and discussion among families are necessary
 
18 to encourage organ donation.
 

 
Page 2                                                     547
                                     H.B. NO.           H.D. 3
                                                        S.D. 2
                                                        C.D. 1
                                                        

 1      The legislature finds and declares that public support of
 
 2 education on organ, tissue, and eye donation is in the public's
 
 3 interest and for the public health, safety, and general welfare.
 
 4      The legislature finds that the Hawaii Organ Procurement
 
 5 Organization d.b.a. Organ Donor Center of Hawaii is a nonprofit
 
 6 and tax exempt organization under Section 501(c)(3) of the
 
 7 Internal Revenue Code.  It was incorporated on July 16, 1987, to
 
 8 "perform or coordinate the performance of retrieving, preserving
 
 9 and locating prospective recipients for available organs."  This
 
10 work includes evaluating potential donors, presenting the option
 
11 of donation to families, providing medical management to donors,
 
12 and placing organs according to nationally established criteria.
 
13 The Health Care Financing Administration (HCFA) has designated it
 
14 as the "organ procurement organization" under Section 1138 of the
 
15 Social Security Act for the State of Hawaii.  Further, the
 
16 legislature finds that the Organ Donor Center of Hawaii meets the
 
17 requirements of a grant recipient under section 42F-103, Hawaii
 
18 Revised Statutes, and that a grant to the Organ Donor Center of
 
19 Hawaii to conduct public education programs and activities on
 
20 organ, tissue, and eye donation is in the public interest and for
 
21 the public health, safety, and general welfare.
 

 
 
 
 
 
Page 3                                                     547
                                     H.B. NO.           H.D. 3
                                                        S.D. 2
                                                        C.D. 1
                                                        

 1      The purpose of this Act is to increase the number of
 
 2 individuals being asked to donate organs, to expand educational
 
 3 efforts across all ethnic, religious, and age groups, to increase
 
 4 the supply of organs for waiting transplant recipients, and to
 
 5 create a special fund which will be used to promote public
 
 6 education programs on organ, tissue, and eye donation.
 
 7      SECTION 2.  Chapter 286, Hawaii Revised Statutes, is amended
 
 8 by adding two new sections to be appropriately designated and to
 
 9 read as follows:
 
10      "�286-A  Organ and tissue education fee.  Notwithstanding
 
11 any other law to the contrary, beginning July 1, 2000, a donation
 
12 of $1, in addition to any other fees under this chapter, may be
 
13 collected upon designation by an individual or entity from each
 
14 certificate of registration by the director of finance of each
 
15 county to be deposited on a quarterly basis into the Hawaii organ
 
16 and tissue education special fund pursuant to section 327-B.  The
 
17 counties may retain a portion of the $1 donation as an
 
18 administrative fee to cover the cost of collecting, accounting
 
19 for, and depositing the balance into the organ and tissue
 
20 education special fund.  The retention shall not exceed $0.20 for
 
21 each $1 collected.
 

 
 
 
 
 
Page 4                                                     547
                                     H.B. NO.           H.D. 3
                                                        S.D. 2
                                                        C.D. 1
                                                        

 1      �286-B  Limited access to driver's license anatomical gift
 
 2 data.  The examiner of drivers shall adopt rules pursuant to
 
 3 chapter 91 to allow an organ procurement organization
 
 4 twenty-four-hour telephone access to the driver's license
 
 5 database information, solely for the purpose of determining
 
 6 whether a driver has indicated a willingness to be an organ donor
 
 7 pursuant to section 286-109.5.
 
 8      As used in this section, "organ procurement organization"
 
 9 shall have the same meaning as procurement organization in
 
10 section 327-1."
 
11      SECTION 3.  Chapter 327, Hawaii Revised Statutes, is amended
 
12 by adding two new sections to be appropriately designated and to
 
13 read as follows:
 
14      "�327-A  Required referral.  (a)  On or before the
 
15 occurrence of each death in an acute care hospital, the hospital
 
16 shall report to the local organ procurement organization to
 
17 determine the suitability of the individual for organ, tissue,
 
18 and eye donation.  This contact shall be noted on the patient's
 
19 medical record.
 
20      (b)  Each acute care hospital shall develop no later than
 
21 July 1, 2000, with the concurrence of the hospital medical staff,
 
22 a protocol for identifying potential organ and tissue donors.
 

 
 
 
Page 5                                                     547
                                     H.B. NO.           H.D. 3
                                                        S.D. 2
                                                        C.D. 1
                                                        

 1 The protocol shall require that at or near the time of every
 
 2 individual death, the acute care hospital shall contact by
 
 3 telephone the local organ procurement organization to determine
 
 4 suitability for organ, tissue, and eye donation of the
 
 5 individual.  Each hospital shall designate a person to contact
 
 6 the local organ procurement organization to provide the
 
 7 appropriate data about the individual necessary to begin
 
 8 assessment for suitability for recovery of anatomical gifts.  The
 
 9 acute care hospital's protocol shall specify the kind of
 
10 information that shall be available prior to making the contact,
 
11 including the patient's age and cause of death.
 
12      The local organ procurement organization, in consultation
 
13 with the patient's attending physician or designee, shall
 
14 determine the suitability for donation.  If the local organ
 
15 procurement organization in consultation with the patient's
 
16 attending physician or designee determines that donation is not
 
17 appropriate based on established medical criteria, this shall be
 
18 noted by the hospital personnel on the patient's record, and no
 
19 further action shall be necessary.  If the local organ
 
20 procurement organization in consultation with the patient's
 
21 attending physician or designee determines that the patient is a
 
22 suitable candidate for anatomical donation, the acute care
 

 
 
 
Page 6                                                     547
                                     H.B. NO.           H.D. 3
                                                        S.D. 2
                                                        C.D. 1
                                                        

 1 hospital and the local organ procurement organization, separately
 
 2 or together, shall initiate a request by a designated requester,
 
 3 who shall be a person trained by the local organ procurement
 
 4 organization.  The protocol shall encourage discretion and
 
 5 sensitivity to family circumstances in all discussions regarding
 
 6 donations of tissue or organs.  The protocol shall take into
 
 7 account the deceased individual's religious beliefs or
 
 8 nonsuitability for organ and tissue donation.
 
 9      (c)  The local organ procurement organization shall conduct
 
10 annual death record reviews at each acute care hospital to
 
11 determine compliance with required referral.  There shall be no
 
12 cost assessed against a hospital for a review of death records
 
13 pursuant to this subsection.
 
14      (d)  As used in this section:
 
15      "Acute care hospital" means a hospital, as defined in
 
16 section 327-1, other than a nursing facility or other long-term
 
17 care facility.
 
18      "Designated requester" means a person who has completed a
 
19 course offered by an organ procurement organization on how to
 
20 approach families and request organ or tissue donation.
 
21      "Organ procurement organization" shall have the same meaning
 
22 as procurement organization in section 327-1.
 

 
 
 
Page 7                                                     547
                                     H.B. NO.           H.D. 3
                                                        S.D. 2
                                                        C.D. 1
                                                        

 1      �327-B  Hawaii organ and tissue education special fund.
 
 2 There is established in the state treasury the Hawaii organ and
 
 3 tissue education special fund.  Moneys collected under section
 
 4 286-A shall be deposited into the fund.  The fund shall be
 
 5 administered and distributed by the department of health and
 
 6 shall be used exclusively for public education programs and
 
 7 activities on organ, tissue, and eye donation."
 
 8      SECTION 4.  Chapter 327, Hawaii Revised Statutes, is amended
 
 9 as follows:
 
10      1.  By amending subsection (h) of section 327-2 to read:
 
11      "(h)  An anatomical gift that is not revoked by the donor
 
12 before death is irrevocable and does not require the consent or
 
13 concurrence of any person after the donor's death.
 
14      Any person, hospital, or organization that relies on the
 
15 document of gift and acts in good faith in accordance with this
 
16 chapter shall not be subject to criminal or civil liability from
 
17 any action taken under this chapter.  The immunity provided by
 
18 this subsection shall not extend to the person, hospital, or
 
19 organization if damages result from the gross negligence,
 
20 recklessness, or intentional misconduct to the donor."
 
21      2.  By repealing section 327-5.
 

 
 
 
 
 
Page 8                                                     547
                                     H.B. NO.           H.D. 3
                                                        S.D. 2
                                                        C.D. 1
                                                        

 1      ["�327-5  Routine inquiry and required request; search and
 
 2 notification.(a)  On or before admission to a hospital, or as
 
 3 soon as possible thereafter, a person designated by the hospital
 
 4 shall ask each patient who is at least eighteen years of age:
 
 5 "Are you an organ or tissue donor?"  If the answer is affirmative
 
 6 the person shall request a copy of the document of gift.  The
 
 7 person designated shall make available basic information
 
 8 regarding the option to make or refuse to make an anatomical
 
 9 gift.  The answer to the question, an available copy of any
 
10 document of gift or refusal, if any, to make an anatomical gift,
 
11 and any other relevant information, shall be placed in the
 
12 patient's medical record.
 
13      (b)  If, at or near the time of death of a patient, there is
 
14 no medical record that the patient has made or refused to make an
 
15 anatomical gift, the hospital administrator or a representative
 
16 designated by the administrator shall discuss the option to make
 
17 or refuse to make an anatomical gift and request the making of an
 
18 anatomical gift pursuant to section 327-3.  The request shall be
 
19 made with reasonable discretion and sensitivity to the
 
20 circumstances of the family including a reciprocal beneficiary.
 
21 A request is not required if the gift is not suitable, based upon
 
22 accepted medical standards, for a purpose specified in section
 

 
 
 
Page 9                                                     547
                                     H.B. NO.           H.D. 3
                                                        S.D. 2
                                                        C.D. 1
                                                        

 1 327-6.  An entry shall be made in the medical record of the
 
 2 patient, stating the name and affiliation of the individual
 
 3 making the request, and of the name, response, and relationship
 
 4 to the patient of the person to whom the request was made.  The
 
 5 director of health may adopt rules to implement this subsection.
 
 6      (c)  The following persons shall, at the person's discretion
 
 7 and if time and resources permit, and if doing so would be
 
 8 inoffensive to anyone in the vicinity of the body, make a
 
 9 reasonable search of the person and the person's immediate
 
10 personal effects for a document of gift or other information
 
11 identifying the bearer as a donor or as an individual who has
 
12 refused to make an anatomical gift:
 
13      (1)  A law enforcement officer, firefighter, paramedic, or
 
14           other emergency rescuer attending an individual who the
 
15           searcher believes to be dead or near death; and
 
16      (2)  A hospital, upon the admission of an individual at or
 
17           near the time of death, if there is not immediately
 
18           available any other source of that information.
 
19      (d)  If a document of gift or evidence of refusal to make an
 
20 anatomical gift is located by the search required by subsection
 
21 (c)(1), and the individual or body to whom it relates is taken to
 
22 a hospital, the hospital shall be notified of the contents and
 
23 the document or other evidence shall be sent to the hospital.
 

 
Page 10                                                    547
                                     H.B. NO.           H.D. 3
                                                        S.D. 2
                                                        C.D. 1
                                                        

 1      (e)  If, at or near the time of death of a patient, a
 
 2 hospital knows that an anatomical gift has been made pursuant to
 
 3 section 327-3 or a release and removal of a part has been
 
 4 permitted pursuant to section 327-4, or that a patient or an
 
 5 individual identified as in transit to the hospital is a donor,
 
 6 the hospital shall notify the donee if one is named and known to
 
 7 the hospital; if not, it shall notify an appropriate procurement
 
 8 organization.  The hospital shall cooperate in the implementation
 
 9 of the anatomical gift or release and removal of a part.
 
10      (f)  A person who fails to discharge the duties imposed by
 
11 this section is not subject to criminal or civil liability but is
 
12 subject to appropriate administrative sanctions."]
 
13      SECTION 5.  The department of health, with the assistance of
 
14 the Organ Donor Center of Hawaii, shall report to the legislature
 
15 no later than twenty days prior to the convening of the regular
 
16 session of 2003, on the deposits and disbursements of the Hawaii
 
17 organ and tissue education special fund and on the effectiveness
 
18 of that fund in achieving its purposes.
 
19      SECTION 6.  There is appropriated out of the organ and
 
20 tissue education special fund for fiscal year 2000-2001 the sum
 
21 of $250,000.  The sum appropriated shall be expended by the
 
22 department of health as a grant to the Organ Donor Center of
 

 
 
 
Page 11                                                    547
                                     H.B. NO.           H.D. 3
                                                        S.D. 2
                                                        C.D. 1
                                                        

 1 Hawaii for the purposes set forth in section 327-B, Hawaii
 
 2 Revised Statutes.
 
 3      SECTION 7.  In codifying the new sections added to chapters
 
 4 286 and 327, Hawaii Revised Statutes, by sections 2 and 3 of this
 
 5 Act, and referred to in this Act, the revisor of statutes shall
 
 6 substitute appropriate section numbers for the letters used in
 
 7 the new sections' designations in this Act.
 
 8      SECTION 8.  Statutory material to be repealed is bracketed.
 
 9 New statutory material is underscored.
 
10      SECTION 9.  This Act shall take effect upon its approval;
 
11 provided that the new sections designated as 286-A and 327-B,
 
12 Hawaii Revised Statutes, in this Act shall take effect on July 1,
 
13 2000, and shall be repealed on June 30, 2003.