[Congressional Record Volume 152, Number 20 (Thursday, February 16, 2006)]
[Senate]
[Pages S1427-S1428]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. LEVIN (for himself, Mr. DeWine, Mr. Dorgan, and Mr. Bond):
  S. 2306. A bill to amend the National Organ Transplant Act to clarify 
that kidney paired donation and kidney list donation do not involve the 
transfer of a human organ for valuable consideration; to the Committee 
on Health, Education, Labor, and Pensions.
  Mr. LEVIN. Mr. President, I am pleased today to be joined by Senators 
DeWine, Dorgan and Bond in introducing legislation that will save lives 
by increasing the number of kidneys available for transplantation. Our 
bill addresses relatively new procedures that did not exist when the 
National Organ Transplant Act--NOTA--was passed more than two decades 
ago. No Federal dollars will be needed to implement it. More 
importantly, it will make it possible for thousands of people who wish 
to donate a kidney to a spouse, family member or friend, but find that 
they are medically incompatible, still to become living kidney donors.
  Kidney paired donations involve two living donors and two 
recipients--the intended recipient of each donor is incompatible with 
the intended donor but compatible with the other donor in the 
arrangement. For example, person A wants to donate her kidney to her 
husband, person B, but cannot because of a biological incompatibility. 
Likewise, person C wants to donate to his wife, person D, and cannot 
because of a biological incompatibility. However, testing reveals that 
A and D are biologically compatible, and C and B are biologically 
compatible. Therefore, a paired kidney donation can be made whereby A 
donates to D and C donates to B. Every paired donation transplant 
avoids burdening the kidney waiting list and increases access to organs 
for all kidney transplant candidates.
  Kidney list donations involve three individuals: a living donor; the 
recipient of the living donor's kidney, who is allocated the organ 
through the waiting list; and the donor's intended recipient who 
receives an allocation priority on the kidney waiting list. In this 
circumstance, a person intends to donate a kidney to a recipient but is 
found to be medically incompatible, and there are no other donor-
recipient pairs available for a simultaneous paired donation. The 
person donates his or her kidney, and the kidney is allocated to a 
medically suitable patient on the national Organ Procurement and 
Transplantation Network--OPTN--waiting list according to OPTN organ 
allocation policy. The donor's originally intended recipient then 
receives allocation priority through the national system to receive a 
deceased donor kidney, thus fulfilling the donor's original intent to 
donate to a particular person. It is estimated that clearing the way 
for these procedures will not only save lives, it would save Medicare 
tens of millions of dollars each year in avoided costs for renal 
dialyses of these patients. By permitting living paired donations, this 
bill will also have the effect of increasing the number of kidneys 
available to patients already on the kidney waiting list.
  The legislation we are introducing removes an unintended impediment 
to kidney donations by clarifying ambiguous language in Section 301 of 
the National Organ Transplant Act--NOTA. That section has been 
interpreted by a number of transplant centers to prohibit such 
donations. In Section 301 of NOTA, Congress prohibited the buying and 
selling of organs. Subsection (a), titled ``Prohibition of organ 
purchases,'' says: ``It shall be unlawful for any person to knowingly 
acquire, receive, or otherwise transfer any human organ for valuable 
consideration. . . . '' The legislation we are introducing does not 
remove or alter any current provision of NOTA, but simply adds a line 
to Section 301 which states that paired donations do not violate it. 
When we originally enacted NOTA we expressly exempted several other 
actions from the valuable consideration provision, such as expressly 
permitting reimbursement of travel and subsistence costs for living 
donors, and for reimbursement of their lost wages. We did not know to 
include paired kidney donation events with these exceptions because 
they were not being performed then.
  Congress surely never intended that the living donation arrangements 
that permit either a kidney paired donation or a kidney list donation 
be impeded by NOTA. Our bill simply makes that clear. A number of 
transplant professionals involved in these and other innovative living 
kidney donation arrangements have proceeded in the reasonable belief 
that these arrangements do not violate Section 301 of NOTA, and they 
are being performed in many states already. This legislation is 
necessary because some have questioned whether these paired donation 
situations might somehow involve valuable consideration in that the 
mutual promises to donate could be considered a thing of value being 
given in exchange for an organ. We do not believe that this is the 
case. Certainly, Congress never intended to impede paired donation when 
it outlawed buying and selling of organs.
  There is no known opposition to this legislation. It is supported by 
numerous medical organizations, including the United Network for Organ 
Sharing, the American Society of Transplant Surgeons, the American 
Society of Transplantation, the National Kidney Foundation and the 
American Society of Pediatric Nephrology.
  It is important that we make the intent of Congress explicit so that 
transplant centers which have hesitated to implement paired donation 
programs can feel free to do so; and in order that the Organ 
Procurement and Transplant Network, which is operated by UNOS under 
contract with the U.S. Department of Health and Human Services, may 
implement a national registry of pairs who need to find other 
compatible pairs so that their loved ones can get the transplant they 
so desperately need.
  The experts in the field of organ donation and transplantation 
estimate that our legislation will result in well over 2,000 additional 
transplants annually and that Medicare would save millions in kidney 
dialysis costs. By its own estimate, Medicare spends more than $55,000 
annually for each dialysis patient, which equates to more than $3.6 
billion per year. Savings to Medicare due to removal of an additional 
2,000 patients from the dialysis program through living kidney donation 
would exceed $110 million. Since the median waiting time for each 
patient is four years, removal of each patient translates into a total 
Medicare savings of $220,000.
  It is our hope that the Senate will promptly act on this necessary 
legislation.
  Mr. DeWINE. Mr. President, I rise today to join with my colleagues, 
Senators Levin, Dorgan, and Bond, to introduce the Living Kidney Organ 
Donation Clarification Act.
  This important legislation would clarify Section 301 of the National 
Organ Transplant Act (NOTA). Section 301 makes it a felony ``for any 
person to knowingly acquire, receive or otherwise transfer any human 
organ for valuable consideration for use in organ transplantation.'' 
This provision simply makes it illegal to buy and sell human organs. 
The bill that Senator Levin and I are introducing would clarify that 
paired donations do not violate Section 301.

[[Page S1428]]

  When NOTA was first enacted, the only living organ donations took 
place between a single biologically compatible living donor and 
recipient. In the past decade, a new type of living donation procedure 
has developed. It's called the paired organ donation. The best way to 
describe a paired donation is through an example: Patient A is on the 
waiting list for a kidney transplant. Various family and friends have 
offered to donate a kidney to Patient A, but none of the potential 
donors are compatible. However, one of Patient A's potential donors is 
compatible with Patient B, who is also on the waiting list for a 
kidney. Patient B has a potential donor who is compatible with Patient 
A. Patient A and B could exchange donors and both get transplants.
  With the development of paired donations, concerns have arisen that 
the mutual promises to donate organs could be considered ``valuable 
consideration'' under Section 301 of NOTA. It is important to note that 
while paired donations were not conceived at the time NOTA was written 
over 20 years ago, they are in keeping with all of NOTA's provisions 
and protections and should be permitted. Paired donors may not receive 
a monetary payment, except for reimbursement for expenses. I don't 
think that Congress would have intended to prohibit the practice of 
paired donations with the enactment of NOTA.
  The benefits of paired donations are tremendous. Successful kidney 
transplants eliminate the need for dialysis for the recipient, as well 
as decrease costs to Medicare. And, the practice of paired donations 
has the potential to increase the number of living donor transplants 
dramatically, as there are a large number of potential living donors 
who are biologically incompatible with their intended recipients.
  My own State of Ohio has the first state-sponsored program that 
arranges paired kidney donations. There have been at least four paired 
kidney donations in Ohio during the last two years arranged through the 
Paired Donation Kidney Consortium. With over 62,000 men, women, and 
children waiting for a kidney donation, we cannot afford to turn our 
back on the paired donation procedure.
  That is why it is critically important that Section 301 of NOTA be 
clarified to permit these donations. Clarification of the intent of 
Congress would encourage transplant centers throughout the country to 
implement their own paired donation programs. It also would enable the 
Organ Procurement and Transplant Network to create a national list of 
pairs of incompatible donors so that as many recipients can be matched 
up as possible.
  I encourage my colleagues to join me in cosponsoring this bill.
  Mr. DORGAN. Mr. President, I am pleased to join Senators Levin, 
DeWine and Bond to introduce the Kidney Transplant Clarification Act of 
2006. This legislation will help save lives by increasing the number of 
kidney donations made by living donors.
  There are currently 90,608 people in the United States who are on the 
national organ transplant waiting list. More than two-thirds of those 
on the waiting list suffer from end stage renal disease and are in need 
of a kidney transplant. Unfortunately, the number of people on the 
waiting list continues to grow far faster than the number of organ 
donors. In North Dakota alone, there are currently 91 patients who are 
waiting for a kidney transplant.
  The good news is that patients with end stage renal disease who 
require a kidney transplant no longer need to wait for a kidney from a 
deceased donor or from a blood relative. Advances in medical science 
now make it possible for friends and spouses to donate a kidney to a 
patient in need. Of the 16,004 kidney transplants in 2004, 6,647 were 
from living donors.
  The bad news is outdated Federal laws inappropriately stand in the 
way of widely adopting several innovative approaches that would 
increase the number of kidney donations from the living.
  One of these strategies is called a paired kidney donation. Here is 
how it works: Joe wants to donate a kidney to his wife Kathleen but 
can't because of incompatibility. Likewise, Suzy wants to donate a 
kidney to her husband Scott but can't because of incompatibility. A 
paired donation helps match up these couples so Joe can donate a kidney 
to Scott and Suzy can donate a kidney to Kathleen.
  The other approach is called a kidney list donation. Here is how it 
works: Rebecca wants to donate a kidney to her husband Grant but can't 
because of incompatibility. In this case, she decides to donate a 
kidney to someone who is already on the national waiting list. Once the 
donation is made, Grant is added to the waiting list but is given 
allocation priority for a kidney that becomes available in the future.
  The Kidney Transplant Clarification Act will clarify that paired and 
list kidney donations are allowed under the National Organ Transplant 
Act, removing a barrier that has prevented more kidney donations from 
living donors from occurring.
  The National Organ Transplant Act, which was enacted in 1984, 
prohibits any person to acquire, receive or donate any human organ for 
anything of value. The purpose of this law is to prohibit the buying 
and selling of human organs. I agree with this law. The last thing that 
we want to do is sanction organ trafficking. Yet, when this law was 
enacted, paired and list kidney donations did not exist. It is 
important that we clarify that these innovative strategies to increase 
the number of kidney donations from living donors are allowed under 
current law.
  The Kidney Transplant Clarification Act will not only save lives, it 
will save the federal government and taxpayers money. Patients with end 
stage renal disease require dialysis, which is covered by Medicare. 
According to the Centers for Medicare and Medicaid Services, Medicare 
spends about $55,000 per patient per year for dialysis. On average, 
patients with end stage renal disease wait 4 years before receiving a 
kidney transplant. This means that every kidney donation made from a 
living donor has the potential to reduce the number of people on the 
waiting list and save the government as much as $220,000.
  Mr. President, I encourage my colleagues to support this legislation.
                                 ______