[House Report 118-611]
[From the U.S. Government Publishing Office]


118th Congress   }                                      {       Report
                        HOUSE OF REPRESENTATIVES
 2d Session      }                                      {      118-611

======================================================================



 
                      HONOR OUR LIVING DONORS ACT

                                _______
                                

 July 23, 2024.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

Mrs. Rodgers of Washington, from the Committee on Energy and Commerce, 
                        submitted the following

                              R E P O R T

                        [To accompany H.R. 6020]

    The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 6020) to amend the Public Health Service Act to 
eliminate consideration of the income of organ recipients in 
providing reimbursement of expenses to donating individuals, 
and for other purposes, having considered the same, reports 
favorably thereon with an amendment and recommends that the 
bill as amended do pass.

                                CONTENTS

                                                                   Page
Purpose and Summary..............................................     2
Background and Need for Legislation..............................     2
Committee Action.................................................     3
Committee Votes..................................................     3
Oversight Findings and Recommendations...........................     5
New Budget Authority, Entitlement Authority, and Tax Expenditures     5
Congressional Budget Office Estimate.............................     5
Federal Mandates Statement.......................................     5
Statement of General Performance Goals and Objectives............     5
Duplication of Federal Programs..................................     5
Related Committee and Subcommittee Hearings......................     5
Committee Cost Estimate..........................................     6
Earmark, Limited Tax Benefits, and Limited Tariff Benefits.......     6
Advisory Committee Statement.....................................     6
Applicability to Legislative Branch..............................     6
Section-by-Section Analysis of the Legislation...................     6
Changes in Existing Law Made by the Bill, as Reported............     7

    The amendment is as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``Honor Our Living Donors Act''.

SEC. 2. NO CONSIDERATION OF INCOME OF ORGAN RECIPIENT.

  Section 377 of the Public Health Service Act (42 U.S.C. 274f) is 
amended--
          (1) by redesignating subsections (c) through (f) as 
        subsections (d) through (g), respectively;
          (2) by inserting after subsection (b) the following:
  ``(c) No Consideration of Income of Organ Recipient.--The recipient 
of a grant under this section, in providing reimbursement to a donating 
individual through such grant, shall not give any consideration to the 
income of the organ recipient.''; and
          (3) in subsection (f), as so redesignated--
                  (A) in paragraph (1), by striking ``subsection 
                (c)(1)'' and inserting ``subsection (d)(1)''; and
                  (B) in paragraph (2), by striking ``subsection 
                (c)(2)'' and inserting ``subsection (d)(2)''.

SEC. 3. REMOVAL OF EXPECTATION OF PAYMENTS BY ORGAN RECIPIENTS.

  Section 377(e) of the Public Health Service Act (42 U.S.C. 274f(e)), 
as redesignated by section 2, is amended--
          (1) in paragraph (1), by adding ``or'' at the end;
          (2) in paragraph (2), by striking ``; or'' and inserting a 
        period; and
          (3) by striking paragraph (3).

SEC. 4. ANNUAL REPORT.

  Section 377 of the Public Health Service Act (42 U.S.C. 274f), as 
amended by sections 2 and 3, is further amended by adding at the end 
the following:
  ``(h) Annual Report.--Not later than December 31 of each year, the 
Secretary shall--
          ``(1) prepare, submit to the Congress, and make public a 
        report on whether grants under this section provided adequate 
        funding during the preceding fiscal year to reimburse all 
        donating individuals participating in the grant program under 
        this section for all qualifying expenses; and
          ``(2) include in each such report--
                  ``(A) the estimated number of all donating 
                individuals participating in the grant program under 
                this section who did not receive reimbursement for all 
                qualifying expenses during the preceding fiscal year; 
                and
                  ``(B) the total amount of funding that is estimated 
                to be necessary to fully reimburse all donating 
                individuals participating in the grant program under 
                this section for all qualifying expenses.''.

                          Purpose and Summary

    The Honor Our Living Donors Act prevents an organ 
recipient's income from being considered when providing 
reimbursement for qualifying expenses incurred by a living 
organ donor during the donation process.

                  Background and Need for Legislation

    The Organ Donation and Recovery Improvement Act (ODRIA) 
established the authority and parameters to provide 
reimbursement to living organ donors for lost wages, dependent 
care, travel, and incidental expenses during the donation 
process.\1\ Since this law was established, the Health 
Resources and Services Administration (HRSA) began supporting 
the National Living Donor Assistance Center (NLDAC) to 
implement the reimbursement program and this has helped make 
more than 9,000 organ donations possible.\2\ While this program 
has clearly helped living donors, it is important to reduce 
barriers to organ donation as there are more than 103,000 
patients on the national transplant waiting list.\3\
---------------------------------------------------------------------------
    \1\Public Law 108-216, Organ Donation and Recovery Improvement Act, 
Section 3.
    \2\National Living Donor Assistance Center, Our Mission, https://
www.livingdonorassistance.org/.
    \3\Health Resources and Services Administration, Organ Donation 
Statistics, https://www.organdonor.gov/learn/organ-donation-statistics.
---------------------------------------------------------------------------
    Under current law, the living donor's reimbursement 
eligibility status is based on the income of both the donor and 
recipient.\4\ This has proven to be an unnecessary barrier to 
living organ donation and has resulted in most living organ 
donors financing their own donations. H.R. 6020 removes the 
requirement for eligibility status to be determined based on 
the income of the intended recipient with the ultimate goal of 
increasing organ donation rates.
---------------------------------------------------------------------------
    \4\Public Health Service Act, Section 377.
---------------------------------------------------------------------------

                            Committee Action

    On February 29, 2024, the Subcommittee on Health held a 
hearing on H.R. 6020. The title of the hearing was 
``Legislative Proposals to Support Patients with Rare 
Diseases.'' The Subcommittee received testimony from:
           Terence Flotte, MD, Provost and Dean of 
        UMass Chan Medical School, Vice President of American 
        Society of Gene and Cell Therapy;
           Alexander Bassuk, MD, PhD, Physician-in-
        Chief, University of Iowa Stead Family Children's 
        Hospital; Chair and Professor, Stead Family Department 
        of Pediatrics;
           Aaron Kesselheim, MD, JD, MPH, Professor of 
        Medicine, Harvard Medical School; Director, Program On 
        Regulation, Therapeutics, And Law (PORTAL) at Brigham 
        and Women's Hospital;
           Jeromie Ballreich, PhD, Associate Research 
        Professor, Johns Hopkins Bloomberg School of Public 
        Health;
           Alice Chen, PhD, Senior Fellow, USC 
        Schaeffer Center for Health Policy and Economics; 
        Associate Professor and Vice Dean for Research, USC Sol 
        Price School of Public Policy; and
           Khrystal Davis, JD, Founding President, 
        Texas Rare Alliance.
    On May 16, 2024, the Subcommittee on Health met in open 
markup session and forwarded H.R. 6020, as amended, to the full 
Committee by a roll call vote of 24 yeas to 0 nays.
    On June 12, 2024, the full Committee on Energy and Commerce 
met in open markup session and ordered H.R. 6020, as amended, 
favorably reported to the House by a record vote of 42 yeas and 
0 nays.

                            Committee Votes

    Clause 3(b) of rule XIII requires the Committee to list the 
record votes on the motion to report legislation and amendments 
thereto. The following reflects the record votes taken during 
the Committee consideration:


    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                 Oversight Findings and Recommendations

    Pursuant to clause 2(b)(1) of rule X and clause 3(c)(1) of 
rule XIII, the Committee held a hearing and made findings that 
are reflected in this report.

   New Budget Authority, Entitlement Authority, and Tax Expenditures

    Pursuant to clause 3(c)(2) of rule XIII, the Committee 
finds that H.R. 6020 would result in no new or increased budget 
authority, entitlement authority, or tax expenditures or 
revenues.

                  Congressional Budget Office Estimate

    Pursuant to clause 3(c)(3) of rule XIII, at the time this 
report was filed, the cost estimate prepared by the Director of 
the Congressional Budget Office pursuant to section 402 of the 
Congressional Budget Act of 1974 was not available.

                       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.

         Statement of General Performance Goals and Objectives

    Pursuant to clause 3(c)(4) of rule XIII, the general 
performance goal or objective of this legislation is to 
eliminate consideration of the income of organ recipients in 
providing reimbursement of expenses to donating individuals.

                    Duplication of Federal Programs

    Pursuant to clause 3(c)(5) of rule XIII, no provision of 
H.R. 6020 is known to be duplicative of another Federal 
program, including any program that was included in a report to 
Congress pursuant to section 21 of Public Law 111-139 or the 
most recent Catalog of Federal Domestic Assistance.

              Related Committee and Subcommittee Hearings

    Pursuant to clause 3(c)(6) of rule XIII, the following 
related hearing was used to develop or consider H.R. 6020:
           On February 29, 2024, the Subcommittee on 
        Health held a hearing on H.R. 6020. The title of the 
        hearing was ``Legislative Proposals to Support Patients 
        with Rare Diseases.'' The Subcommittee received 
        testimony from:
                   Terence Flotte, MD, Provost and 
                Dean of UMass Chan Medical School, Vice 
                President of American Society of Gene and Cell 
                Therapy;
                   Alexander Bassuk, MD, PhD, 
                Physician-in-Chief, University of Iowa Stead 
                Family Children's Hospital; Chair and 
                Professor, Stead Family Department of 
                Pediatrics;
                   Aaron Kesselheim, MD, JD, MPH, 
                Professor of Medicine, Harvard Medical School; 
                Director, Program On Regulation, Therapeutics, 
                And Law (PORTAL) at Brigham and Women's 
                Hospital;
                   Jeromie Ballreich, PhD, 
                Associate Research Professor, Johns Hopkins 
                Bloomberg School of Public Health;
                   Alice Chen, PhD, Senior Fellow, 
                USC Schaeffer Center for Health Policy and 
                Economics; Associate Professor and Vice Dean 
                for Research, USC Sol Price School of Public 
                Policy; and
                   Khrystal Davis, JD, Founding 
                President, Texas Rare Alliance.

                        Committee Cost Estimate

    Pursuant to clause 3(d)(1) of rule XIII, 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. At the time this report was 
filed, the estimate was not available.

       Earmark, Limited Tax Benefits, and Limited Tariff Benefits

    Pursuant to clause 9(e), 9(f), and 9(g) of rule XXI, the 
Committee finds that H.R. 6020 contains no earmarks, limited 
tax benefits, or limited tariff benefits.

                      Advisory Committee Statement

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act were created by this 
legislation.

                  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

    Section 1 provides that the Act may be cited as the ``Honor 
Our Living Donors Act.''

Section 2. No consideration of income of organ recipient

    Section 2 provides that there shall be no consideration of 
income of the organ recipient when determining reimbursement 
eligibility for the living organ donor.

Section 3. Removal of expectation of payments of organ recipients

    Section 3 provides that there shall be no consideration of 
whether the organ recipient could reasonably make payments to 
the living donor for qualified expenses.

Section 4. Annual report

    Section 4 requires the Secretary of the Department of 
Health and Human Services to prepare and submit a report to 
Congress on whether grants under this section provided adequate 
funding to reimburse all donating individuals for qualifying 
expenses.

         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 italics, and 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. REIMBURSEMENT OF TRAVEL AND SUBSISTENCE EXPENSES INCURRED 
                    TOWARD LIVING ORGAN DONATION.

  (a) In General.--The Secretary may award grants 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 reimbursement of travel and 
        subsistence expenses incurred by individuals toward 
        making living donations of their organs (in this 
        section referred to as ``donating individuals''); and
          (2) providing for the reimbursement of such 
        incidental nonmedical expenses that are so incurred as 
        the Secretary determines by regulation to be 
        appropriate.
  (b) Preference.--The Secretary shall, in carrying out 
subsection (a), give preference to those individuals that the 
Secretary determines are more likely to be otherwise unable to 
meet such expenses.
  (c) No Consideration of Income of Organ Recipient.--The 
recipient of a grant under this section, in providing 
reimbursement to a donating individual through such grant, 
shall not give any consideration to the income of the organ 
recipient.
  [(c)] (d) Certain Circumstances.--The Secretary may, in 
carrying out subsection (a), consider--
          (1) 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; and
          (2) the term ``qualifying expenses'' as including the 
        expenses of having relatives or other individuals, not 
        to exceed 2, accompany or assist the donating 
        individual for purposes of subsection (a) (subject to 
        making payment for only those types of expenses that 
        are paid for a donating individual).
  [(d)] (e) 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[; or].
          [(3) by the recipient of the organ.]
  [(e)] (f) Definitions.--For purposes of this section:
          (1) The term ``donating individuals'' has the meaning 
        indicated for such term in subsection (a)(1), subject 
        to [subsection (c)(1)] subsection (d)(1).
          (2) The term ``qualifying expenses'' means the 
        expenses authorized for purposes of subsection (a), 
        subject to [subsection (c)(2)] subsection (d)(2).
  [(f)] (g) 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 2005 
through 2009.
  (h) Annual Report.--Not later than December 31 of each year, 
the Secretary shall--
          (1) prepare, submit to the Congress, and make public 
        a report on whether grants under this section provided 
        adequate funding during the preceding fiscal year to 
        reimburse all donating individuals participating in the 
        grant program under this section for all qualifying 
        expenses; and
          (2) include in each such report--
                  (A) the estimated number of all donating 
                individuals participating in the grant program 
                under this section who did not receive 
                reimbursement for all qualifying expenses 
                during the preceding fiscal year; and
                  (B) the total amount of funding that is 
                estimated to be necessary to fully reimburse 
                all donating individuals participating in the 
                grant program under this section for all 
                qualifying expenses.

           *       *       *       *       *       *       *


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