[House Report 107-11]
[From the U.S. Government Publishing Office]
107th Congress Report
HOUSE OF REPRESENTATIVES
1st Session 107-11
======================================================================
ORGAN DONATION IMPROVEMENT ACT OF 2001
March 6, 2001.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Tauzin, from the Committee on Energy and Commerce, submitted the
following
R E P O R T
[To accompany H.R. 624]
[Including cost estimate of the Congressional Budget Office]
The Committee on Energy and Commerce, to whom was referred
the bill (H.R. 624) to amend the Public Health Service Act to
promote organ donation, having considered the same, report
favorably thereon without amendment and recommend that the bill
do pass.
CONTENTS
Page
Purpose and Summary.............................................. 1
Background and Need for Legislation.............................. 2
Hearings......................................................... 3
Committee Consideration.......................................... 3
Committee Votes.................................................. 3
Committee Oversight Findings..................................... 3
Statement of General Performance Goals and Objectives............ 3
New Budget Authority, Entitlement Authority, and Tax Expenditures 3
Committee Cost Estimate.......................................... 3
Congressional Budget Office Estimate............................. 3
Federal Mandates Statement....................................... 5
Advisory Committee Statement..................................... 5
Constitutional Authority Statement............................... 5
Applicability to Legislative Branch.............................. 5
Section-by-Section Analysis of the Legislation................... 5
Changes in Existing Law Made by the Bill, as Reported............ 6
Purpose and Summary
H.R. 624, the Organ Donation Improvement Act of 2001, is
solely focused on creating new incentives for people to become
organ donors and provides for studies and demonstration
projects to encourage organ donation education efforts across
the country. The bill accomplishes this objective by permitting
the Secretary of the Department of Health and Human Services to
make awards of grants or contracts to States, transplant
centers, qualified organ procurement organizations, or other
public or private entities for the purpose of providing for the
payment of travel and subsistence expenses incurred by
individuals toward making living donations of their organs. In
addition, the bill orders the Secretary to carry out studies
and demonstration projects for the purpose of educating the
public with respect to organ donation. These grants will assist
the States in carrying out organ donor awareness, public
education, and outreach activities, and programs designed to
increase the number of organ donors within a State, including
living donors.
Background and Need for Legislation
In 1999, 21,715 Americans received the ``gift of life''
through transplantation surgery made possible by the generosity
of organ and tissue donors. Despite the self-sacrifice and
charity of these donors, this is only a small proportion of the
more than 70,000 Americans who are now on a waiting list,
hoping to prolong their lives by finding a matching donor.
Tragically, the number of patients waiting for organ
transplants rose more than five times as fast as the number of
transplant operations in the 1990s, according to an annual
report by the United Network for Organ Sharing (UNOS). Nearly
5,000 patients each year (or 13 patients each day), die while
waiting for a donated heart, liver, kidney, or other organ. It
is estimated that every 16 minutes, a new name is added to this
growing waiting list.
Minorities representing approximately 25 percent of the
population comprise over 40 percent of the organ transplant
waiting list, and half of the patients who die while patiently
waiting for their ``gift of life'' are people of color.
As the demand for transplantation increases, this shortfall
in donor organs for those with end-stage organ disease or organ
failure will become even more pronounced. In order to narrow
the gap between the supply and the increasing demand for
donated organs, there must be an effort to encourage willing
donors and create an environment conducive to organ donation.
In the last two Congresses, the Committee has held three
hearings on solid organ transplantation. Among the issues
raised in these hearings included the need for increasing organ
donation through initiatives like those included in H.R. 624.
The Committee found that there are willing donors who would
like to save the life of another American, but often find
themselves in financial circumstances that would make donation
of a life-saving organ even more of a hardship. Travel
expenses, lengthy hospital stays, and time away from one's job
can all create financial and emotional strains on donor
families. These hardships discourage organ donation.
The Committee also found that our Nation's organ donation
education efforts need to be strengthened in order to increase
the number of donors, and encourage family members to discuss
organ and tissue donation at appropriate times. In addition,
States need additional funds in order to bolster their organ
donor awareness, public education, and outreach activities.
Obstacles to organ donation create disincentives for
willing donors and ultimately increase waiting times and
waiting lists for patients with end-stage organ disease and
organ failure.
The organ donation provisions contained in H.R. 624 are the
same provisions that were the subject of markup in Subcommittee
(September 30, 1999), markup in Full Committee (October 13,
1999), and House passage (April 4, 2000 by a vote of 275-147)
of H.R. 2418, the Organ Procurement and Transplantation Network
Amendments of 2000. The votes against H.R. 2418 were focused on
the provisions relating to Secretarial authority over the
allocation process, which have not been included in H.R. 624.
Hearings
The Committee on Energy and Commerce has not held hearings
on this bill.
Committee Consideration
On February 28, 2001, the Subcommittee on Health was
discharged from the further consideration of H.R. 624. On
February 28, 2001, the Full Committee met in open markup
session and approved H.R. 624, without amendment, by a voice
vote.
Committee Votes
Clause 3(b) of rule XIII of the Rules of the House of
Representatives requires the Committee to list the record votes
on the motion to report legislation and amendments thereto.
There were no record votes taken in connection with ordering
H.R. 624 reported.
Committee Oversight Findings
Pursuant to clause 3(c)(1) of rule XIII of the Rules of the
House of Representatives, the Committee has held no oversight
hearing.
Statement of General Performance Goals and Objectives
This legislation will improve the rate of organ donations
by providing new incentives for donations and requiring studies
of organ donations.
New Budget Authority, Entitlement Authority, and Tax Expenditures
In compliance with clause 3(c)(2) of rule XIII of the Rules
of the House of Representatives, the Committee finds that H.R.
624, the Organ Donation Improvement Act of 2001, would result
in no new or increased budget authority, entitlement authority,
or tax expenditures or revenues.
Committee Cost Estimate
The Committee adopts as its own the cost estimate prepared
by the Director of the Congressional Budget Office pursuant to
section 402 of the Congressional Budget Act of 1974.
Congressional Budget Office Estimate
Pursuant to clause 3(c)(3) of rule XIII of the Rules of the
House of Representatives, the following is the cost estimate
provided by the Congressional Budget Office pursuant to section
402 of the Congressional Budget Act of 1974:
U.S. Congress,
Congressional Budget Office,
Washington, DC, March 6, 2001.
Hon. W.J. ``Billy'' Tauzin,
Chairman, Committee on Energy and Commerce,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 624, the Organ
Donation Improvement Act of 2001.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Mara Krause.
Sincerely,
Barry B. Anderson
(For Dan L. Crippen, Director).
Enclosure.
H.R. 624--Organ Donation Improvement Act of 2001
H.R. 624 would amend the Public Health Service Act to
promote organ donation. The bill, as modified, would authorize
appropriation of $5 million a year in 2002 through 2006 for
travel and subsistence expenses for qualifying individuals
making living donation of their organs. H.R. 624, as modified,
would also authorize appropriation of $15 million in fiscal
year 2002 for a program to educate the public and for studies
and demonstrations designed to increase the rate of organ
donation. It would authorize such sums as may be necessary for
these activities from 2003 through 2006.
Assuming appropriations of the necessary amounts, CBO
estimates that implementing H.R. 624 would cost $6 million in
2002 and a total of $78 million from 2002 through 2006, without
adjusting for inflation, and $80 million if inflation
adjustments are included. The legislation would not affect
direct spending or receipts; therefore, pay-as-you-go
procedures would not apply.
The estimated budgetary impact of H.R. 624 is shown in the
following table. The table shows two alternative spending
paths: one assuming no increases to account for anticipated
inflation, and one with annual inflation adjustments. For
purposes of this estimate, CBO assumes that outlays will follow
historical spending rates for similar activities. The costs of
this legislation fall within budget function 550 (health).
H.R. 624 contains no private-sector or intergovernmental
mandates as defined in the Unfunded Mandates Reform Act. The
bill would provide grants to states and other public and
private entities for assistance to individuals who donate
living organs and for educational and outreach activities.
----------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars--
-----------------------------------------------------
2001 2002 2003 2004 2005 2006
----------------------------------------------------------------------------------------------------------------
CHANGES IN SPENDING SUBJECT TO APPROPRIATION
Without Adjustments for Inflation
Estimated Authorization Level............................. 0 20 20 20 20 20
Estimate Outlays.......................................... 0 6 15 18 20 20
With Adjustments for Inflation
Estimated Authorization Level............................. 0 20 20 21 21 21
Estimate Outlays.......................................... 0 6 15 19 20 21
----------------------------------------------------------------------------------------------------------------
The CBO staff contact is Mara Krause. This estimate was
approved by Peter H. Fontaine, Deputy Assistant Director for
Budget Analysis.
Federal Mandates Statement
The Committee adopts as its own the estimate of Federal
mandates prepared by the Director of the Congressional Budget
Office pursuant to section 423 of the Unfunded Mandates Reform
Act.
Advisory Committee Statement
No advisory committees within the meaning of section 5(b)
of the Federal Advisory Committee Act were created by this
legislation.
Constitutional Authority Statement
Pursuant to clause 3(d)(1) of rule XIII of the Rules of the
House of Representatives, the Committee finds that the
Constitutional authority for this legislation is provided in
Article I, section 8, clause 3, which grants Congress the power
to regulate commerce with foreign nations, among the several
States, and with the Indian tribes.
Applicability to Legislative Branch
The Committee finds that the legislation does not relate to
the terms and conditions of employment or access to public
services or accommodations within the meaning of section
102(b)(3) of the Congressional Accountability Act.
Section-by-Section Analysis of the Legislation
Section 1. Short title
This section provides the short title of the bill, the
``Organ Donation Improvement Act of 2001.''
Section 2. Sense of Congress
Section 2 sets out the sense of Congress with respect to
organ donation and recognizes the importance of family
discussions on organ donation. This section also acknowledges
the generous contributions made by living organ donors, and the
remarkable advances in medical technology which have made organ
transplantation possible.
Section 3. Payment of travel and subsistence expenses incurred toward
living organ donation
Section 3 amends Section 377 of the Public Health Service
Act to permit the Secretary of the Department of Health and
Human Services to make awards of grants or contracts to States,
transplant centers, qualified organ procurement organizations,
or other public or private entities for the purpose of
providing for the payment of travel and subsistence expenses
incurred by individuals toward making living donations of their
organs. Payments under this section may be made for expenses of
a donating individual only if: (1) the State in which the
donating individual resides is a different State than the State
in which the intended recipient of the organ resides and (2)
the annual income of the intended recipient of the organ does
not exceed $35,000.
While Section 4 of H.R. 624 authorizes a grant program to
the separate States to increase organ donation, which could
establish their own travel and subsistence programs, the
Section 3 program is for those donations affecting interstate
commerce (hence the requirement that the recipient must reside
in a State other than the residence of the living donor). The
amount of qualifying expenses for which payments under such
subsection are made may not exceed the amount of such expenses
for which payment would have been made if such area had been
the covered vicinity for the intended recipient, taking into
account the costs of travel and regional differences in the
costs of living. Capping qualifying expenses to that which
might be incurred at a local transplant center was a solution
proposed to control costs of the program. While recipients can
receive a transplant from any place they desire, reimbursed
expenses would be limited to the equivalent of having gone to
the transplant center closest to the residence of the
recipient.
Likewise, the annual income of the intended recipient of
the organ was capped at $35,000 for the Section 3 program,
because it was established to assist those recipients of
relatively modest means who may not be in a position to make a
prospective donor whole financially for lost wages and costs
associated with travel.
Section 4. Public awareness; studies and demonstrations
Section 4 amends Part H of title III of the Public Health
Service Act to permit the Secretary to make grants to the
States to carry out studies and demonstration projects for the
purpose of educating the public with respect to organ donation.
These grants will assist the States in carrying out organ donor
awareness, public education, and outreach activities, and
programs designed to increase the number of organ donors within
a State, including living donors. Each state would be required
to establish yearly benchmarks for improving organ donation
rates in the State; develop, enhance, or expand the State's
donor registry; and, report to the Secretary on an annual basis
an assessment of the State's use of these grant funds.
Section 5. Effective date
The amendments made by this act take effect on the date of
enactment.
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italic, existing law in which no change is
proposed is shown in roman):
PUBLIC HEALTH SERVICE ACT
* * * * * * *
TITLE III--GENERAL POWERS AND DUTIES OF PUBLIC HEALTH SERVICE
* * * * * * *
Part H--Organ Transplants
* * * * * * *
[SEC. 377. STUDY BY GENERAL ACCOUNTING OFFICE.
[(a) In General.--The Comptroller General of the United
States shall conduct a study for the purpose of determining--
[(1) the extent to which the procurement and
allocation of organs have been equitable, efficient,
and effective;
[(2) the problems encountered in the procurement and
allocation; and
[(3) the effect of State required-request laws.
[(b) Report.--Not later than January 7, 1992, the Comptroller
General of the United States shall complete the study required
in subsection (a) and submit to the Committee on Energy and
Commerce of the House of Representatives, and to the Committee
on Labor and Human Resources of the Senate, a report describing
the findings made as a result of the study.]
payment of travel and subsistence expenses incurred toward living organ
donation
Sec. 377. (a) In General.--The Secretary may make awards of
grants or contracts to States, transplant centers, qualified
organ procurement organizations under section 371, or other
public or private entities for the purpose of--
(1) providing for the payment of travel and
subsistence expenses incurred by individuals toward
making living donations of their organs (in this
section referred as ``donating individuals''); and
(2) in addition, providing for the payment of such
incidental nonmedical expenses that are so incurred as
the Secretary determines by regulation to be
appropriate.
(b) Eligibility.--
(1) In general.--Payments under subsection (a) may be
made for the qualifying expenses of a donating
individual only if--
(A) the State in which the donating
individual resides is a different State than
the State in which the intended recipient of
the organ resides; and
(B) the annual income of the intended
recipient of the organ does not exceed $35,000
(as adjusted for fiscal year 2001 and
subsequent fiscal years to offset the effects
of inflation occurring after the beginning of
fiscal year 2000).
(2) Certain circumstances.--Subject to paragraph (1),
the Secretary may in carrying out subsection (a)
provide as follows:
(A) The Secretary may consider the term
``donating individuals'' as including
individuals who in good faith incur qualifying
expenses toward the intended donation of an
organ but with respect to whom, for such
reasons as the Secretary determines to be
appropriate, no donation of the organ occurs.
(B) The Secretary may consider the term
``qualifying expenses'' as including the
expenses of having one or more family members
of donating individuals accompany the donating
individuals for purposes of subsection (a)
(subject to making payment for only such types
of expenses as are paid for donating
individuals).
(c) Limitation on Amount of Payment.--
(1) In general.--With respect to the geographic area
to which a donating individual travels for purposes of
subsection (a), if such area is other than the covered
vicinity for the intended recipient of the organ, the
amount of qualifying expenses for which payments under
such subsection are made may not exceed the amount of
such expenses for which payment would have been made if
such area had been the covered vicinity for the
intended recipient, taking into account the costs of
travel and regional differences in the costs of living.
(2) Covered vicinity.--For purposes of this section,
the term ``covered vicinity'', with respect to an
intended recipient of an organ from a donating
individual, means the vicinity of the nearest
transplant center to the residence of the intended
recipient that regularly performs transplants of that
type of organ.
(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
payment has been made, or can reasonably be expected to be
made, with respect to such expenses--
(1) under any State compensation program, under an
insurance policy, or under any Federal or State health
benefits program; or
(2) by an entity that provides health services on a
prepaid basis.
(e) Definitions.--For purposes of this section:
(1) The term ``covered vicinity'' has the meaning
given such term in subsection (c)(2).
(2) The term ``donating individuals'' has the meaning
indicated for such term in subsection (a)(1), subject
to subsection (b)(2)(A).
(3) The term ``qualifying expenses'' means the
expenses authorized for purposes of subsection (a),
subject to subsection (b)(2)(B).
(f) Authorization of Appropriations.--For the purpose of
carrying out this section, there is authorized to be
appropriated $5,000,000 for each of the fiscal years 2000
through 2005.
public awareness; studies and demonstrations
Sec. 377A. (a) Public Awareness.--The Secretary shall
(directly or through grants or contracts) carry out a program
to educate the public with respect to organ donation, including
the need to provide for an adequate rate of such donations.
(b) Studies and Demonstrations.--The Secretary may make
grants to public and nonprofit private entities for the purpose
of carrying out studies and demonstration projects with respect
to providing for an adequate rate of organ donation.
(c) Grants to States.--The Secretary may make grants to
States for the purpose of assisting States in carrying out
organ donor awareness, public education and outreach activities
and programs designed to increase the number of organ donors
within the State, including living donors. To be eligible, each
State shall--
(1) submit an application to the Department in the
form prescribed;
(2) establish yearly benchmarks for improvement in
organ donation rates in the State;
(3) develop, enhance or expand a State donor
registry, which shall be available to hospitals, organ
procurement organizations, and other States upon a
search request; and
(4) report to the Secretary on an annual basis a
description and assessment of the State's use of these
grant funds, accompanied by an assessment of
initiatives for potential replication in other States.
Funds may be used by the State or in partnership with other
public agencies or private sector institutions for education
and awareness efforts, information dissemination, activities
pertaining to the State organ donor registry, and other
innovative donation specific initiatives, including living
donation.
(d) Annual Report to Congress.--The Secretary shall annually
submit to the Congress a report on the activities carried out
under this section, including provisions describing the extent
to which the activities have affected the rate of organ
donation.
(e) Authorization of Appropriations.--
(1) In general.--For the purpose of carrying out this
section, there are authorized to be appropriated
$15,000,000 for fiscal year 2000, and such sums as may
be necessary for each of the fiscal years 2001 through
2005. Such authorization of appropriations is in
addition to any other authorizations of appropriations
that is available for such purpose.
(2) Studies and demonstrations.--Of the amounts
appropriated under paragraph (1) for a fiscal year, the
Secretary may not obligate more than $2,000,000 for
carrying out subsection (b).
* * * * * * *