A bill to amend the Public Health Service Act to promote organ donation, and for other purposes.

Summary: Organ Donation and Recovery Improvement Act - (Sec. 2) Expresses the sense of Congress that the Federal Government should carry out programs to educate the public with respect to organ donation, including the need to provide for an adequate rate of donations. States that Congress: (1) acknowledges the importance of discussing organ and tissue donation as a family; (2) recognizes the contribution made by each living individual who has donated an organ; and (3) acknowledges the advances in medical technology that have enabled organ transplantation through living organ donors to become a viable treatment option.

(Sec. 3) Amends the Public Health Service Act to authorize the Secretary of Health and Human Services to award grants to States, transplant centers, qualified organ procurement organizations or other public or private entities for reimbursement of travel and subsistence expenses incurred by individuals toward making living organ donations. Authorizes FY 2004 through 2008 appropriations.

(Sec. 4) Directs the Secretary to: (1) directly or through grants or contracts, establish a public education program to increase awareness about organ donation and the need to provide for an adequate rate of donations; and (2) support the development and dissemination of educational materials to inform health care professionals about organ, tissue, and eye donation issues, including those relating to patient, family, and cultural sensitivities.

Authorizes the Secretary to make: (1) peer reviewed grants or contracts to public and nonprofit private entities for studies and demonstration projects to increase organ donation and recovery rates, including living donation; and (2) grants to States for organ donor awareness, public education and outreach activities, and programs designed to increase the number of organ donors within the State, including living donors.

Authorizes additional FY 2004 through 2008 appropriations for such studies and grants.

Authorizes the Secretary to award matching grants to qualified organ procurement organizations and hospitals to establish programs coordinating organ donation activities of eligible hospitals and qualified organ procurement organizations. (Defines an eligible hospital as a hospital that performs significant trauma care, or a hospital or consortium of hospitals that serves a population base of not fewer than 200,000 individuals.) Requires a grantee to: (1) establish joint organ procurement organization and hospital designated leadership responsibility and accountability; (2) develop agreed upon project performance goals; and (3) collaboratively design and implement a data collection process to provide ongoing project feedback. Authorizes FY 2004 through 2008 appropriations.

(Sec. 5) Directs the Secretary, through the Director of the Agency for Healthcare Research and Quality, to: (1) develop scientific evidence supporting increased donation and improved recovery, preservation, and transportation of donated organs; and (2) support efforts to develop a uniform clinical vocabulary and technology and to enhance the skills of the organ procurement workforce. Authorizes FY 2004 through 2008 appropriations.

(Sec. 6) Directs the Secretary, by December 31, 2005, and biennially thereafter, to report on organ donation and recovery activities.

(Sec. 7) Authorizes the Secretary to establish and maintain mechanisms to evaluate the long-term effects associated with living organ donations by individuals who have served as living donors.

(Sec. 8) Directs the Secretary, in consultation with appropriate entities, including advocacy groups for populations that are likely to be disproportionately affected by proposals to increase cadaveric donation, to report on the ethical implications of such proposals.

(Sec. 9) Eliminates certain grant authority with respect to qualified organ procurement organizations.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Organ Donation and Recovery 
Improvement Act''.

SEC. 2. SENSE OF CONGRESS.

    (a) Public Awareness of Need for Organ Donation.--It is the sense 
of Congress that the Federal Government should carry out programs to 
educate the public with respect to organ donation, including the need 
to provide for an adequate rate of such donations.
    (b) Family Discussions of Organ Donations.--Congress recognizes the 
importance of families pledging to each other to share their lives as 
organ and tissue donors and acknowledges the importance of discussing 
organ and tissue donation as a family.
    (c) Living Donations of Organs.--Congress--
            (1) recognizes the generous contribution made by each 
        living individual who has donated an organ to save a life; and
            (2) acknowledges the advances in medical technology that 
        have enabled organ transplantation with organs donated by 
        living individuals to become a viable treatment option for an 
        increasing number of patients.

SEC. 3. REIMBURSEMENT OF TRAVEL AND SUBSISTENCE EXPENSES INCURRED 
              TOWARD LIVING ORGAN DONATION.

    Section 377 of the Public Health Service Act (42 U.S.C. 274f) is 
amended to read as follows:

``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) 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, who 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) 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;
            ``(2) by an entity that provides health services on a 
        prepaid basis; or
            ``(3) by the recipient of the organ.
    ``(e) 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).
            ``(2) The term `qualifying expenses' means the expenses 
        authorized for purposes of subsection (a), subject to 
        subsection (c)(2).
    ``(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 2004 through 2008.''.

SEC. 4. PUBLIC AWARENESS; STUDIES AND DEMONSTRATIONS.

    Part H of title III of the Public Health Service Act (42 U.S.C. 273 
et seq.) is amended by inserting after section 377 the following:

``SEC. 377A. PUBLIC AWARENESS; STUDIES AND DEMONSTRATIONS.

    ``(a) Organ Donation Public Awareness Program.--The Secretary 
shall, directly or through grants or contracts, establish a public 
education program in cooperation with existing national public 
awareness campaigns to increase awareness about organ donation and the 
need to provide for an adequate rate of such donations.
    ``(b) Studies and Demonstrations.--The Secretary may make peer 
reviewed grants or contracts to public and nonprofit private entities 
for the purpose of carrying out studies and demonstration projects to 
increase organ donation and recovery rates, including living 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; and
            ``(3) 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 
donor registry, and other innovative donation specific initiatives, 
including living donation.
    ``(d) Educational Activities.--The Secretary, in coordination with 
the Organ Procurement and Transplantation Network and other appropriate 
organizations, shall support the development and dissemination of 
educational materials to inform health care professionals and other 
appropriate professionals in issues surrounding organ, tissue, and eye 
donation including evidence-based proven methods to approach patients 
and their families, cultural sensitivities, and other relevant issues.
    ``(e) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated $15,000,000 
for fiscal year 2004, and such sums as may be necessary for each of the 
fiscal years 2005 through 2008. Such authorization of appropriations is 
in addition to any other authorizations of appropriations that are 
available for such purpose.

``SEC. 377B. GRANTS REGARDING HOSPITAL ORGAN DONATION COORDINATORS.

    ``(a) Authority.--
            ``(1) In general.--The Secretary may award grants to 
        qualified organ procurement organizations and hospitals under 
        section 371 to establish programs coordinating organ donation 
        activities of eligible hospitals and qualified organ 
        procurement organizations under section 371. Such activities 
        shall be coordinated to increase the rate of organ donations 
        for such hospitals.
            ``(2) Eligible hospital.--For purposes of this section, an 
        eligible hospital is a hospital that performs significant 
        trauma care, or a hospital or consortium of hospitals that 
        serves a population base of not fewer than 200,000 individuals.
    ``(b) Administration of Coordination Program.--A condition for the 
receipt of a grant under subsection (a) is that the applicant involved 
agree that the program under such subsection will be carried out 
jointly--
            ``(1) by representatives from the eligible hospital and the 
        qualified organ procurement organization with respect to which 
        the grant is made; and
            ``(2) by such other entities as the representatives 
        referred to in paragraph (1) may designate.
    ``(c) Requirements.--Each entity receiving a grant under subsection 
(a) shall--
            ``(1) establish joint organ procurement organization and 
        hospital designated leadership responsibility and 
        accountability for the project;
            ``(2) develop mutually agreed upon overall project 
        performance goals and outcome measures, including interim 
        outcome targets; and
            ``(3) collaboratively design and implement an appropriate 
        data collection process to provide ongoing feedback to hospital 
        and organ procurement organization leadership on project 
        progress and results.
    ``(d) Rule of Construction.--Nothing in this section shall be 
construed to interfere with regulations in force on the date of 
enactment of the Organ Donation and Recovery Improvement Act.
    ``(e) Evaluations.--Within 3 years after the award of grants under 
this section, the Secretary shall ensure an evaluation of programs 
carried out pursuant to subsection (a) in order to determine the extent 
to which the programs have increased the rate of organ donation for the 
eligible hospitals involved.
    ``(f) Matching Requirement.--The Secretary may not award a grant to 
a qualifying organ donation entity under this section unless such 
entity agrees that, with respect to costs to be incurred by the entity 
in carrying out activities for which the grant was awarded, the entity 
shall contribute (directly or through donations from public or private 
entities) non-Federal contributions in cash or in kind, in an amount 
equal to not less than 30 percent of the amount of the grant awarded to 
such entity.
    ``(g) Funding.--For the purpose of carrying out this section, there 
are authorized to be appropriated $3,000,000 for fiscal year 2004, and 
such sums as may be necessary for each of fiscal years 2005 through 
2008.''.

SEC. 5. STUDIES RELATING TO ORGAN DONATION AND THE RECOVERY, 
              PRESERVATION, AND TRANSPORTATION OF ORGANS.

    Part H of title III of the Public Health Service Act (42 U.S.C. 273 
et seq.) is amended by inserting after section 377B, as added by 
section 4, the following:

``SEC. 377C. STUDIES RELATING TO ORGAN DONATION AND THE RECOVERY, 
              PRESERVATION, AND TRANSPORTATION OF ORGANS.

    ``(a) Development of Supportive Information.--The Secretary, acting 
through the Director of the Agency for Healthcare Research and Quality 
shall develop scientific evidence in support of efforts to increase 
organ donation and improve the recovery, preservation, and 
transportation of organs.
    ``(b) Activities.--In carrying out subsection (a), the Secretary 
shall--
            ``(1) conduct or support evaluation research to determine 
        whether interventions, technologies, or other activities 
        improve the effectiveness, efficiency, or quality of existing 
        organ donation practice;
            ``(2) undertake or support periodic reviews of the 
        scientific literature to assist efforts of professional 
        societies to ensure that the clinical practice guidelines that 
        they develop reflect the latest scientific findings;
            ``(3) ensure that scientific evidence of the research and 
        other activities undertaken under this section is readily 
        accessible by the organ procurement workforce; and
            ``(4) work in coordination with the appropriate 
        professional societies as well as the Organ Procurement and 
        Transplantation Network and other organ procurement and 
        transplantation organizations to develop evidence and promote 
        the adoption of such proven practices.
    ``(c) Research and Dissemination.--The Secretary, acting through 
the Director of the Agency for Healthcare Research and Quality, as 
appropriate, shall provide support for research and dissemination of 
findings, to--
            ``(1) develop a uniform clinical vocabulary for organ 
        recovery;
            ``(2) apply information technology and telecommunications 
        to support the clinical operations of organ procurement 
        organizations;
            ``(3) enhance the skill levels of the organ procurement 
        workforce in undertaking quality improvement activities; and
            ``(4) assess specific organ recovery, preservation, and 
        transportation technologies.
    ``(d) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated $2,000,000 
for fiscal year 2004, and such sums as may be necessary for each of 
fiscal years 2005 through 2008.''.

SEC. 6. REPORT RELATING TO ORGAN DONATION AND THE RECOVERY, 
              PRESERVATION, AND TRANSPORTATION OF ORGANS.

    Part H of title III of the Public Health Service Act (42 U.S.C. 273 
et seq.) is amended by inserting after section 377C, as added by 
section 5, the following:

``SEC. 377D. REPORT RELATING TO ORGAN DONATION AND THE RECOVERY, 
              PRESERVATION, AND TRANSPORTATION OF ORGANS.

    ``(a) In General.--Not later than December 31, 2005, and every 2 
years thereafter, the Secretary shall report to the appropriate 
committees of Congress on the activities of the Department carried out 
pursuant to this part, including an evaluation describing the extent to 
which the activities have affected the rate of organ donation and 
recovery.
    ``(b) Requirements.--To the extent practicable, each report 
submitted under subsection (a) shall--
            ``(1) evaluate the effectiveness of activities, identify 
        effective activities, and disseminate such findings with 
        respect to organ donation and recovery;
            ``(2) assess organ donation and recovery activities that 
        are recently completed, ongoing, or planned; and
            ``(3) evaluate progress on the implementation of the plan 
        required under subsection (c)(4).
    ``(c) Initial Report Requirements.--The initial report under 
subsection (a) shall include the following:
            ``(1) An evaluation of the organ donation practices of 
        organ procurement organizations, States, other countries, and 
        other appropriate organizations including an examination across 
        all populations, including those with low organ donation rates, 
        of--
                    ``(A) existing barriers to organ donation; and
                    ``(B) the most effective donation and recovery 
                practices.
            ``(2) An evaluation of living donation practices and 
        procedures. Such evaluation shall include an assessment of 
        issues relating to informed consent and the health risks 
        associated with living donation (including possible reduction 
        of long-term effects).
            ``(3) An evaluation of--
                    ``(A) federally supported or conducted organ 
                donation efforts and policies, as well as federally 
                supported or conducted basic, clinical, and health 
                services research (including research on preservation 
                techniques an organ rejection and compatibility); and
                    ``(B) the coordination of such efforts across 
                relevant agencies within the Department and throughout 
                the Federal Government.
            ``(4) An evaluation of the costs and benefits of State 
        donor registries, including the status of existing State donor 
        registries, the effect of State donor registries on organ 
        donation rates, issues relating to consent, and recommendations 
        regarding improving the effectiveness of State donor registries 
        in increasing overall organ donation rates.
            ``(5) A plan to improve federally supported or conducted 
        organ donation and recovery activities, including, when 
        appropriate, the establishment of baselines and benchmarks to 
        measure overall outcomes of these programs. Such plan shall 
        provide for the ongoing coordination of federally supported or 
        conducted organ donation and research activities.''.

SEC. 7. NATIONAL LIVING DONOR MECHANISMS.

    Part H of title III of the Public Health Service Act (42 U.S.C. 273 
et seq.), is amended by inserting after section 371 the following:

``SEC. 371A. NATIONAL LIVING DONOR MECHANISMS.

    ``The Secretary is authorized to establish and maintain mechanisms 
to evaluate the long-term effects associated with living organ 
donations by individuals who have served as living donors.''.

SEC. 8. STUDY.

    Not later than December 31, 2004, the Secretary of Health and Human 
Services, in consultation with appropriate entities, including advocacy 
groups representing those populations that are likely to be 
disproportionately affected by proposals to increase cadaveric 
donation, shall submit to the appropriate committees of Congress a 
report that evaluates the ethical implications of such proposals.

SEC. 9. QUALIFIED ORGAN PROCUREMENT ORGANIZATIONS.

    Section 371(a) of the Public Health Service Act (42 U.S.C. 273(a)) 
is amended by striking paragraph (3).

            Passed the Senate November 25, 2003.

            Attest:

                                                             Secretary.
108th CONGRESS

  1st Session

                                 S. 573

_______________________________________________________________________

                                 AN ACT

 To amend the Public Health Service Act to promote organ donation, and 
                          for other purposes.