[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4343 Introduced in House (IH)]
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118th CONGRESS
1st Session
H. R. 4343
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
June 23, 2023
Ms. Matsui (for herself and Mr. Wilson of South Carolina) 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 Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Organ Donation Clarification Act of
2023''.
SEC. 2. FINDINGS.
Congress finds the following:
(1) As of May 2023, 113,999 people await an organ
transplant, with 95,957 of those people waiting for a kidney,
and average wait times are approaching five years for a kidney,
with over one-and-a-half times as many people being added to
the waiting lists as getting a transplant.
(2) Of the nearly three million Americans who die annually,
under 30,000, representing about one percent of all deaths each
year, possess major organs healthy enough for transplanting.
(3) On average, 17 people a day died while waiting for an
organ in 2020, with the majority of those people waiting for a
kidney.
(4) In 2022, approximately 4,498 people were removed from
kidney waiting lists and approximately 1,500 from liver
(1,123), heart (239), and lungs (145) waiting lists because
they became permanently too sick to receive a transplant.
(5) Over 75 percent of dialysis patients are not employed
because dialysis requires multiple treatments per week which
last several hours and leave patients drained, thus creating a
huge financial burden on the patients, their families, and the
government; moreover, lost tax revenue from these individuals
is not included in the cost estimates above.
(6) A patient receiving a kidney transplant, and thus no
longer needing dialysis, can enjoy a much higher quality of
life for another 10-15 years on average.
(7) As medical advances extend people's lives on dialysis,
the number of patients on dialysis will increase significantly,
as will the costs for individuals and the Federal Government.
(8) Roughly seven percent of the Medicare budget goes to
the End Stage Renal Disease Program, with dialysis costing
Medicare over $90,000 per patient per year, as Federal law
dictates that Medicare will cover dialysis for everyone who has
made minimal Social Security tax payments.
(9) A kidney transplant pays for itself in less than two
years, with each transplant saving an average of $136,000 in
medical costs over a 10-year period, 75 percent of which is
savings to the taxpayers.
(10) Experts project that if the supply of transplant
kidneys could be increased to meet the demand, taxpayers would
save more than $16,000,000,000 per year in medical costs.
(11) The World Health Organization estimates that 10
percent of all transplants take place on the international
black market, the last choice for desperate patients facing an
alternative of death, however recipients often receive infected
kidneys and suffer poor health outcomes and donors are often
victimized.
(12) Present policy on domestic donation has never been
subject to studies or pilots to determine effectiveness in
increasing the availability of donated organs and the
effectiveness of safeguards that prevent coercion or
exploitation, precludes all but altruistic donation,
prohibiting any form of incentive or benefit for donors.
(13) In 2010, Israel implemented sweeping changes to its
national organ donation program including reducing financial
burdens on donors, giving future transplantation priority to
registered organ donors and their families, and promoting
donation by reimbursing the donor's medical costs, 40 days of
lost wages, and five years of medical and life insurance costs,
and as a result saw organ donation approximately triple over a
10-year period.
(14) Experts are arriving at a consensus that trials are
necessary to find new methods of promoting additional organ
donation which will save lives and reduce organ trafficking.
SEC. 3. CLARIFICATION OF CERTAIN PROVISIONS OF THE NATIONAL ORGAN
TRANSPLANT ACT.
(a) Valuable Consideration.--Section 301(c)(2) of the National
Organ Transplant Act (42 U.S.C. 274e(c)(2)) is amended to read as
follows:
``(2) The term `valuable consideration' does not include
the following:
``(A) Reasonable payments associated with the
removal, transportation, implantation, processing,
preservation, quality control, and storage of a human
organ.
``(B) Advanced payments or reimbursement for
travel, lodging, food during travel, and other
logistical expenses related to donation.
``(C) Advanced payments or reimbursement for
dependent care expenses related to donation before,
during, or after the donation, but not later than the
date that is 10 years after the date of the donation.
``(D) Advanced payments or reimbursement for lost
wages related to donation.
``(E) Medical expenses related to donation and all
related follow-up care including preventative follow-up
care and medication for up to a 10-year period.
``(F) Paperwork or legal costs related to donation.
``(G) Any term life insurance policy against the
risk of death or disability as a result of donating an
organ or the longer-term health effects of having
donated an organ, that--
``(i) in the case of a life insurance
policy, provides for payments in amounts less
than $2,000,000, adjusted annually for
inflation; and
``(ii) in the case of a disability
insurance policy, provides for payments equal
to or less than the reasonable earnings
expectations of the donor.''.
(b) Covered Pilot Program.--Section 301 of the National Organ
Transplant Act (42 U.S.C. 274e) is amended by adding at the end the
following:
``(d) Covered Pilot Program Encouraging Organ Donation.--
``(1) Approval.--The Secretary may approve covered pilot
programs for purposes of applying the exception in paragraph
(2).
``(2) Exception to prohibition.--Subsection (a) does not
prohibit--
``(A) acquisition, receipt, or transfer of any
noncash benefit provided pursuant to a covered pilot
program; or
``(B) other actions taken to carry out a covered
pilot program.
``(3) Definitions.--In this subsection:
``(A) The term `covered pilot program' means a
pilot program that--
``(i) is conducted by the Federal
Government or any State, territory, Tribe, or
local government;
``(ii) is approved by the Secretary under
paragraph (1);
``(iii) is subject to an ethical review
board process;
``(iv) has a term of not more than 5 fiscal
years;
``(v) is for the purpose of providing, or
allowing the provision of, noncash benefits for
organ donation and organ donors, and measuring
the effects of providing such noncash benefits;
``(vi) measures the effects of providing
such noncash benefits; and
``(vii) allows for the determination of the
recipient of an organ donated pursuant to the
covered pilot program--
``(I) in the case of organs from
deceased donors, only by the Organ
Procurement and Transplantation
Network; and
``(II) in the case of nondirected
organs from living donors, only by a
transplant center that is a member of,
and abides by the rules and
requirements of, the Organ Procurement
and Transplantation Network established
pursuant to section 372 of the Public
Health Service Act.
``(B) The term `noncash benefit' means any benefit
or thing of value received by an organ donor that is
impossible to sell, trade, or otherwise transfer to
another individual.
``(4) Report to congress.--Not later than three years after
the Secretary first approves a covered pilot program, and every
three years thereafter until there is no longer a covered pilot
program in operation, the Secretary shall submit a report to
the Congress on--
``(A) the impact of covered pilot programs on the
organ pool;
``(B) the demographics of the donors participating
in covered pilot programs;
``(C) the demographics of the recipients of organs
donated by participants in covered pilot programs;
``(D) the effectiveness, fairness, and
equitableness of the distribution of nondirected living
donor organs that are donated by participants in
covered pilot programs; and
``(E) recommendations to Congress on--
``(i) improving covered pilot programs; and
``(ii) expanding the use of noncash
benefits to incentivize organ donation.''.
(c) Relationship to Payments by Recipient of Organ.--Subsection (d)
of section 377 of the Public Health Service Act (42 U.S.C. 274f(d)) is
amended to read as follows:
``(d) Relationship to Payments Under Other Programs.--An award may
be made under subsection (a) only if the applicant involved agrees that
the award will not be expended to pay the qualifying expenses of a
donating individual to the extent that--
``(1) payment has been made, or can reasonably be expected
to be made, with respect to such expenses--
``(A) under any State compensation program, under
an insurance policy, or under any Federal or State
health benefits program; or
``(B) by an entity that provides health services on
a prepaid basis; or
``(2) the recipient of the organ has made payment, or had
agreed to make payment, with respect to such expenses.''.
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