[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6448 Introduced in House (IH)]

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115th CONGRESS
  2d Session
                                H. R. 6448

To amend the National Organ Transplant Act to clarify the definition of 
 valuable consideration, to clarify that pilot programs that honor and 
 reward organ donation do not violate that Act, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 19, 2018

  Mr. Cartwright (for himself, Mr. Lewis of Minnesota, Mr. Cohen, Mr. 
 Grijalva, Ms. Jenkins of Kansas, Ms. Eddie Bernice Johnson of Texas, 
 Mr. Khanna, Mr. Marino, Mr. Polis, Mr. Young of Alaska, Mr. Bishop of 
  Georgia, Mr. Fitzpatrick, Mr. Posey, Mr. Kelly of Pennsylvania, Mr. 
  McGovern, and Mr. Carson of Indiana) 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 
 reward 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 
2018''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) As of June 2018, 115,000 people await an organ 
        transplant, with 95,000 of those people waiting for a kidney, 
        and average wait times are approaching five years for a kidney, 
        with twice as many people being added to waiting lists as 
        getting a transplant.
            (2) Living donor kidney transplants peaked in 2004 and have 
        declined since due to a scarcity of living donors.
            (3) Of the roughly two million Americans who die annually, 
        only 10,500 to 13,800, representing less than one percent of 
        all deaths each year, possess major organs healthy enough for 
        transplanting.
            (4) On average, 20 people a day died while waiting for an 
        organ in 2017, with the majority of those people waiting for a 
        kidney.
            (5) In 2017, 4,700 people were permanently removed from 
        kidney waiting lists and 1,800 from liver, heart, and lungs 
        waiting lists because they became permanently too sick to 
        receive a transplant.
            (6) Ninety 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 which is not included in the cost estimates above, 
        and which can help lead to as few as ten percent of dialysis 
        patients being employed.
            (7) A patient receiving a kidney transplant on average can 
        go 10-15 years living without dialysis while enjoying a much 
        higher quality of life.
            (8) 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.
            (9) Roughly seven percent of the Medicare budget goes to 
        the End Stage Renal Disease Program, with dialysis costing 
        Medicare over $87,000 per patient per year, as Federal law 
        dictates that Medicare will cover dialysis for everyone who has 
        made minimal Social Security tax payments.
            (10) A kidney transplant pays for itself in less than two 
        years, with each transplant saving an average of over $700,000 
        in medical costs over a 10-year period, 85 percent of which is 
        savings to the taxpayers.
            (11) Experts project that if the supply of transplant 
        kidneys could be increased to meet the demand, taxpayers would 
        save more than $12,000,000,000 per year in medical costs.
            (12) 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 face infected 
        kidneys and have poor health outcomes and donors are often 
        victimized.
            (13) Present policy on domestic donation, which is not 
        evidence based and 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.
            (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) Relation to Other Laws.--Section 301 of the National Organ 
Transplant Act (42 U.S.C. 274e) is amended by adding at the end the 
following:
    ``(d) Relation to Other Laws.--
            ``(1) Governments encouraging organ donation.--This section 
        shall not--
                    ``(A) apply to actions taken by the Government of 
                the United States or any State, territory, tribe, or 
                local government of the United States to carry out a 
                covered pilot program; or
                    ``(B) prohibit acceptance of any noncash benefits 
                provided by the pilot program under subparagraph (A).
            ``(2) No prohibition on other benefits programs.--Nothing 
        in this subsection shall be construed to prohibit actions, 
        other than actions described in this section, taken by any 
        State, territory, tribe, or unit of local government in the 
        United States to provide benefits for human organ donation.
            ``(3) Covered pilot program.--For purposes of this 
        subsection, the term `covered pilot program' means a pilot 
        program approved by the Secretary of Health and Human Services, 
        subject to an ethical review board process, with a term of not 
        more than 5 fiscal years, for the purpose of measuring the 
        effect of removing disincentives or providing a noncash benefit 
        that may increase the organ pool. Distributions of organs from 
        deceased donors under the pilot program shall be conducted only 
        through the Organ Procurement and Transplantation Network at a 
        transplant center approved by the United Network for Organ 
        Sharing or any other entity designated by the Secretary of 
        Health and Human Services.''.
    (b) 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) Reimbursement for travel, lodging, food 
                during travel, and other logistical expenses related to 
                donation.
                    ``(C) Provision of advanced payments or 
                reimbursement for dependent care needs for pre-
                transplant appointments in addition to during the 
                period of donation and post-transplant follow up care 
                related to the donation for up to a 10-year period.
                    ``(D) 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 
                        greater than $2,000,000, adjusted annually for 
                        inflation; and
                            ``(ii) in the case of a disability 
                        insurance policy, provides for payments beyond 
                        the reasonable earnings expectations of the 
                        donor.''.
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