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.  Creates an advisory
committee on anatomical gifts.  (HB547 HD3)

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                        547
HOUSE OF REPRESENTATIVES                H.B. NO.           H.D. 3
TWENTIETH LEGISLATURE, 1999                                
STATE OF HAWAII                                            
                                                             
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                   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 that destroy healthy organs and require replacement.  The chances
 
13 of finding a good organ match is increased if the donor is of the
 
14 same ethnic group as the transplant recipient.  Minority ethnic
 
15 groups must be educated in the great need among their own people
 
16 for anatomical gifts.  The legislature finds that more education
 
17 and discussion among families are necessary to encourage organ
 
18 donation.
 
19      The purpose of this Act is to increase the number of
 
20 patients being asked to donate organs, to expand educational
 

 
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 1 efforts across all ethnic, religious, and age groups, and to
 
 2 increase the supply of organs for waiting transplant recipients.
 
 3      SECTION 2.  Chapter 286, Hawaii Revised Statutes, is amended
 
 4 by adding two new sections to be appropriately designated and to
 
 5 read as follows:
 
 6      "§286-A  Organ and tissue education fee.  Notwithstanding
 
 7 any other law to the contrary, beginning July 1, 2000, a
 
 8 voluntary fee of $1 for each certificate of registration or
 
 9 driver's license application or renewal shall be collected
 
10 annually by the director of finance of each county to be
 
11 deposited into the Hawaii organ and tissue education special fund
 
12 pursuant to section 327-C.
 
13      §286-B  Limited access to driver's license anatomical gift
 
14 data.  The examiner of drivers shall adopt rules pursuant to
 
15 chapter 91 to allow an appropriate organ, tissue, and eye
 
16 recovery agency or organ procurement organization to twenty-four-
 
17 hour telephone access to the driver's license database
 
18 information, solely for the purpose of determining whether a
 
19 driver has indicated a willingness to be an organ donor pursuant
 
20 to section 286-109.5 when the information is requested pursuant
 
21 to section 327-A."
 
22      SECTION 3.  Chapter 327, Hawaii Revised Statutes, is amended
 
23 by adding three new sections to be appropriately designated and
 
24 to read as follows:
 

 
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                                     H.B. NO.           H.D. 3
                                                        
                                                        

 
 1      "§327-A  Required referral.  (a)  On or before the
 
 2 occurrence of each death in an acute care hospital, the hospital
 
 3 shall report to the appropriate organ, tissue, or eye recovery
 
 4 agency in order to determine the suitability of the individual
 
 5 for organ, tissue, and eye donation.  This contact shall be noted
 
 6 on the patient's medical record.
 
 7      (b)  Each acute care hospital shall develop within one year
 
 8 of the effective date of this Act, with the concurrence of the
 
 9 hospital medical staff, a protocol for identifying potential
 
10 organ and tissue donors.  The protocol shall require that at or
 
11 near the time of every individual death, the acute care hospital
 
12 shall contact by telephone the local organ procurement
 
13 organization to determine suitability for organ, tissue, and eye
 
14 donation of the individual.  Each hospital shall designate a
 
15 person to contact the organ procurement organization to provide
 
16 the appropriate data about the individual necessary to begin
 
17 assessment for suitability for recovery of anatomical gifts.  The
 
18 acute care hospital's protocol shall specify the kind of
 
19 information that shall be available prior to making the contact,
 
20 including the patient's age and cause of death.
 
21      The organ procurement organization, in consultation with the
 
22 patient's attending physician or designee, shall determine the
 
23 suitability for donation.  If the organ procurement organization
 

 
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 1 in consultation with the patient's attending physician or
 
 2 designee determines that donation is not appropriate based on
 
 3 established medical criteria, this shall be noted by the hospital
 
 4 personnel on the patient's record, and no further action shall be
 
 5 necessary.  If the organ procurement organization in consultation
 
 6 with the patient's attending physician or designee determines
 
 7 that the patient is a suitable candidate for anatomical donation,
 
 8 the acute care hospital and the organ procurement organization,
 
 9 separately or together, shall initiate a request by a designated
 
10 requester, who shall be a person trained by the organ procurement
 
11 organization.  The protocol shall encourage discretion and
 
12 sensitivity to family circumstances in all discussions regarding
 
13 donations of tissue or organs.  The protocol shall take into
 
14 account the deceased individual's religious beliefs or
 
15 nonsuitability for organ and tissue donation.
 
16      (c)  The organ procurement organization shall conduct annual
 
17 death record reviews at each acute care hospital to determine
 
18 compliance with required referral.  There shall be no cost
 
19 assessed against a hospital for a review of death records
 
20 pursuant to this subsection.
 
21      (d)  As used in this section, "designated requester" means a
 
22 person who has completed a course offered by an organ procurement
 
23 organization on how to approach families and request organ or
 
24 tissue donation.
 

 
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                                     H.B. NO.           H.D. 3
                                                        
                                                        

 
 1      §327-B  Advisory committee on anatomical gifts.  (a)  There
 
 2 is established within the department of health for administrative
 
 3 purposes the advisory committee on anatomical gifts.  The
 
 4 committee shall consist of:
 
 5      (1)  At least twenty members but not more than twenty-five
 
 6           members appointed by the governor as provided in
 
 7           section 26-34; and
 
 8      (2)  The lieutenant governor, who shall serve as an ex-
 
 9           officio member.
 
10 Members shall serve without compensation but shall be reimbursed
 
11 for expenses, including travel expenses, necessary for the
 
12 performance of their duties.
 
13      (b)  There shall be at least one member representing each of
 
14 the following categories:
 
15      (1)  Transplant physicians;
 
16      (2)  Organ donor center of Hawaii;
 
17      (3)  Hawaii lions eye bank and Makana foundation;
 
18      (4)  Minority organ tissue transplant education program;
 
19      (5)  St. Francis transplant center;
 
20      (6)  National kidney foundation of Hawaii;
 
21      (7)  Hawaii medical association;
 
22      (8)  Hawaii nurses' association;
 
23      (9)  American heart association;
 
24     (10)  Hawaii healthcare association;
 

 
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 1     (11)  Donor family members;
 
 2     (12)  Transplant recipients international organization;
 
 3     (13)  Transplant candidates;
 
 4     (14)  Clergy;
 
 5     (15)  Department of education;
 
 6     (16)  Department of health; and
 
 7     (17)  Representatives of the general public, including
 
 8           individuals from the fields of law, theology, ethics,
 
 9           health care financing, the social and behavioral
 
10           sciences, and labor and management unrelated to the
 
11           field of health care.
 
12 Every effort shall be made to select members from every island
 
13 and from rural and urban areas for maximum geographic
 
14 representation.  A majority of the members then serving shall
 
15 constitute a quorum.  Members shall select a chair, who shall
 
16 serve for two years.
 
17     (c)  The committee shall meet at least semiannually or at the
 
18 call of the chairperson to:
 
19     (1)   Promote educational programs to increase awareness of
 
20           organ donation needs; and
 
21     (2)   Engage in any other information, educational, and
 
22           promotional efforts that will help to increase organ,
 
23           tissue, and eye donation.
 

 
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                                     H.B. NO.           H.D. 3
                                                        
                                                        

 
 1     (d)  The lieutenant governor is designated as the primary
 
 2 government official to promote organ donation awareness and shall
 
 3 assist in any way to promote educational programs to promote
 
 4 organ donation.
 
 5     §327-C  Hawaii organ and tissue education special fund.  (a)
 
 6 There is established in the state treasury the Hawaii organ and
 
 7 tissue education special fund.  The fund shall be administered by
 
 8 the department of health and shall be used for educational
 
 9 purposes to promote organ, tissue, and eye donation programs in
 
10 schools, motor vehicle registration offices, buses, libraries,
 
11 government offices, and other public places.
 
12     (b) Moneys in the Hawaii organ and tissue education special
 
13 fund shall be distributed to the Organ Donor Center of Hawaii,
 
14 which shall apportion these moneys as follows:
 
15     (1)   Thirty per cent to the minority organ tissue transplant
 
16           education program;
 
17     (2)   Twenty per cent to Hawaii's federally-designated organ
 
18           procurement organization for the development of public
 
19           education programs; and
 
20     (3)   Fifty per cent to Hawaii's coalition of organ donation
 
21           related agencies for public education programs and
 
22           activities."
 
23     SECTION 4.  Chapter 327, Hawaii Revised Statutes, is amended
 
24 as follows:
 

 
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                                     H.B. NO.           H.D. 3
                                                        
                                                        

 
 1     1.  By amending subsection (h) of section 327-2 to read:
 
 2     "(h)  An anatomical gift that is not revoked by the donor
 
 3 before death is irrevocable and does not require the consent or
 
 4 concurrence of any person after the donor's death.
 
 5     Any person, hospital, or organization that relies on the
 
 6 document of gift and acts in good faith in accordance with this
 
 7 chapter shall not be subject to criminal or civil liability from
 
 8 any action taken under this chapter.  The immunity provided by
 
 9 this subsection shall not extend to such person, hospital, or
 
10 organization if damages result from the gross negligence,
 
11 recklessness, or intentional misconduct to the decedent."
 
12     2.  By repealing section 327-5.
 
13     ["§327-5  Routine inquiry and required request; search and
 
14 notification.(a)  On or before admission to a hospital, or as
 
15 soon as possible thereafter, a person designated by the hospital
 
16 shall ask each patient who is at least eighteen years of age:
 
17 "Are you an organ or tissue donor?"  If the answer is affirmative
 
18 the person shall request a copy of the document of gift.  The
 
19 person designated shall make available basic information
 
20 regarding the option to make or refuse to make an anatomical
 
21 gift.  The answer to the question, an available copy of any
 
22 document of gift or refusal, if any, to make an anatomical gift,
 
23 and any other relevant information, shall be placed in the
 
24 patient's medical record.
 

 
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                                     H.B. NO.           H.D. 3
                                                        
                                                        

 
 1     (b)  If, at or near the time of death of a patient, there is
 
 2 no medical record that the patient has made or refused to make an
 
 3 anatomical gift, the hospital administrator or a representative
 
 4 designated by the administrator shall discuss the option to make
 
 5 or refuse to make an anatomical gift and request the making of an
 
 6 anatomical gift pursuant to section 327-3.  The request shall be
 
 7 made with reasonable discretion and sensitivity to the
 
 8 circumstances of the family including a reciprocal beneficiary.
 
 9 A request is not required if the gift is not suitable, based upon
 
10 accepted medical standards, for a purpose specified in section
 
11 327-6.  An entry shall be made in the medical record of the
 
12 patient, stating the name and affiliation of the individual
 
13 making the request, and of the name, response, and relationship
 
14 to the patient of the person to whom the request was made.  The
 
15 director of health may adopt rules to implement this subsection.
 
16     (c)  The following persons shall, at the person's discretion
 
17 and if time and resources permit, and if doing so would be
 
18 inoffensive to anyone in the vicinity of the body, make a
 
19 reasonable search of the person and the person's immediate
 
20 personal effects for a document of gift or other information
 
21 identifying the bearer as a donor or as an individual who has
 
22 refused to make an anatomical gift:
 

 
 
 
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                                     H.B. NO.           H.D. 3
                                                        
                                                        

 
 1     (1)   A law enforcement officer, firefighter, paramedic, or
 
 2           other emergency rescuer attending an individual who the
 
 3           searcher believes to be dead or near death; and
 
 4     (2)   A hospital, upon the admission of an individual at or
 
 5           near the time of death, if there is not immediately
 
 6           available any other source of that information.
 
 7     (d)  If a document of gift or evidence of refusal to make an
 
 8 anatomical gift is located by the search required by subsection
 
 9 (c)(1), and the individual or body to whom it relates is taken to
 
10 a hospital, the hospital shall be notified of the contents and
 
11 the document or other evidence shall be sent to the hospital.
 
12     (e)  If, at or near the time of death of a patient, a
 
13 hospital knows that an anatomical gift has been made pursuant to
 
14 section 327-3 or a release and removal of a part has been
 
15 permitted pursuant to section 327-4, or that a patient or an
 
16 individual identified as in transit to the hospital is a donor,
 
17 the hospital shall notify the donee if one is named and known to
 
18 the hospital; if not, it shall notify an appropriate procurement
 
19 organization.  The hospital shall cooperate in the implementation
 
20 of the anatomical gift or release and removal of a part.
 
21     (f)  A person who fails to discharge the duties imposed by
 
22 this section is not subject to criminal or civil liability but is
 
23 subject to appropriate administrative sanctions."]
 

 
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                                     H.B. NO.           H.D. 3
                                                        
                                                        

 
 1     SECTION 5.  In codifying the new sections added to chapters
 
 2 286 and 327, Hawaii Revised Statutes, by sections 2 and 3 of this
 
 3 Act, the revisor of statutes shall substitute appropriate section
 
 4 numbers for the letters used in the new sections' designations in
 
 5 this Act.
 
 6     SECTION 6.  Statutory material to be repealed is bracketed.
 
 7 New statutory material is underscored.
 
 8     SECTION 7.  This Act shall take effect upon its approval.