79–006 

115TH CONGRESS REPORT " ! HOUSE OF REPRESENTATIVES 1st Session 115–393 

VETERANS TRANSPLANT COVERAGE ACT OF 2017 

NOVEMBER 7, 2017.—Committed to the Committee of the Whole House on the State 

of the Union and ordered to be printed 

Mr. ROE of Tennessee, from the Committee on Veterans’ Affairs, 

submitted the following 

R E P O R T 

[To accompany H.R. 1133] 

The Committee on Veterans’ Affairs, to whom was referred the 

bill (H.R. 1133) to amend title 38, United States Code, to authorize 

the Secretary of Veterans Affairs to provide for an operation on a 

live donor for purposes of conducting a transplant procedure for a 

veteran, and for other purposes, having considered the same, report 

favorably thereon with an amendment and recommend that the bill 

as amended do pass. 

CONTENTS 

Page 

Purpose and Summary ............................................................................................ 2 

Background and Need for Legislation .................................................................... 2 

Hearings ................................................................................................................... 4 

Subcommittee Consideration .................................................................................. 4 

Committee Consideration ........................................................................................ 4 

Committee Votes ...................................................................................................... 5 

Committee Oversight Findings ............................................................................... 5 

Statement of General Performance Goals and Objectives .................................... 5 

New Budget Authority, Entitlement Authority, and Tax Expenditures ............. 5 

Earmarks and Tax and Tariff Benefits .................................................................. 5 

Committee Cost Estimate ....................................................................................... 5 

Budget Authority and Congressional Budget Office Cost Estimate .................... 6 

Federal Mandates Statement ................................................................................. 6 

Advisory Committee Statement .............................................................................. 6 

Statement of Constitutional Authority .................................................................. 6 

Applicability to Legislative Branch ........................................................................ 6 

Statement on Duplication of Federal Programs .................................................... 6 

Disclosure of Directed Rulemaking ........................................................................ 7 

Section-by-Section Analysis of the Legislation ...................................................... 7 

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: 

2 

1 VA National Transplant Program. https://www.va.gov/health/services/transplant/ 

Accessed October 30, 2017. 2 Ibid. 

SECTION 1. SHORT TITLE. 

This Act may be cited as the ‘‘Veterans Transplant Coverage Act of 2017’’. 

SEC. 2. AUTHORIZATION TO PROVIDE FOR OPERATIONS ON LIVE DONORS FOR PURPOSES OF 

CONDUCTING TRANSPLANT PROCEDURES FOR VETERANS. 

(a) IN GENERAL.—Subchapter VIII of chapter 17 of title 38, United States Code, 

is amended by adding at the end the following new section: 

‘‘§ 1788. Transplant procedures with live donors and related services 

‘‘(a) IN GENERAL.—In a case in which a veteran is eligible for a transplant procedure from the Department, the Secretary may provide for an operation on a live 

donor to carry out such procedure for such veteran, notwithstanding that the live 

donor may not be eligible for health care from the Department. 

‘‘(b) OTHER SERVICES.—Subject to the availability of appropriations for such purpose, the Secretary shall furnish to a live donor any care or services before and after 

conducting the transplant procedure under subsection (a) that may be required in 

connection with such procedure. 

‘‘(c) USE OF DEPARTMENT OR NON-DEPARTMENT FACILITIES.—The Secretary may 

provide for the operation described in subsection (a) on a live donor and furnish to 

the live donor the care and services described in subsection (b) at a facility of the 

Department or at a non-Department facility pursuant to an agreement entered into 

by the Secretary under section 1703 or 8153 of this title, section 101 of the Veterans 

Access, Choice, and Accountability Act of 2014 (Public Law 113–146; 38 U.S.C. 1701 

note), or any other authority of the Secretary to furnish care at non-Department facilities. The live donor shall be deemed to be an individual eligible for hospital care 

and medical services at a non-Department facility pursuant to such an agreement 

solely for the purposes of receiving such operation, care, and services at the nonDepartment facility.’’. 

(b) CLERICAL AMENDMENT.—The table of sections at the beginning of chapter 17 

of such title is amended by inserting after the item relating to section 1787 the following new item: 

‘‘1788. Transplant procedures with live donors and related services.’’. 

PURPOSE AND SUMMARY

H.R. 1133, as amended, the ‘‘Veterans Transplant Coverage Act 

of 2017,’’ would authorize the Department of Veterans Affairs (VA) 

to provide for any care or services a live donor may require to carry 

out a transplant procedure—in either a VA medical facility or a 

medical facility in the community—for an eligible veteran notwithstanding that the live donor may not be eligible for VA health care. 

Representative John Carter of Texas introduced H.R. 1133 on February 16, 2017. 

BACKGROUND AND NEED FOR LEGISLATION

VA has offered solid organ transplant services for eligible veteran 

patients since 1962 and bone marrow transplant services for eligible veteran patients since 1982.1 Through VA’s National Transplant Program, VA provides transplants primarily through 13 VA 

transplant centers located in: Palo Alto, California; Portland, Oregon; Seattle, Washington; Houston, Texas; San Antonio, Texas; 

Salt Lake City, Utah; Iowa City, Iowa; Madison, Wisconsin; Birmingham, Alabama; Nashville, Tennessee; West Roxbury, Massachusetts; Bronx, New York; Pittsburgh, Pennsylvania; and Richmond, Virginia.2

The Veterans Access, Choice, and Accountability Act of 2014 

(Public Law 113–146; 128 STAT. 1754) created the Choice program 

to increase access to care in the community for veteran patients 

unable to receive care at VA medical facilities due to long waiting 

3 

3 United States Cong. House Committee on Veterans’ Affairs. Legislative Hearing. October 24, 

2017. 115th Cong. 1st sess. Washington: GPO, 2017 (statement for the record Representative 

John Carter). 4 Ibid. 

5 Ibid. 

6Fox 7, ‘‘Leander Veteran Fighting for VA to Pay for Kidney Transplant,’’ May 24, 2016, 

http://www.fox7austin.com/news/local-news/disabled-leander-veteran-fighting-to-get-va-to-payfor-kidney-transplant. 7 United States Cong. House Committee on Veterans’ Affairs. Legislative Hearing. October 24, 

2017. 115th Cong. 1st sess. Washington: GPO, 2017 (statement for the record Representative 

John Carter). 8 Ibid. 

9 Journal of the American Medical Association, ‘‘Association of Distance from a Transplant 

Center with Access to Waitlist Placement, Receipt of Liver Transplantation, and Survival 

Among U.S. Veterans, June 29, 2016, https://www.ncbi.nlm.nih.gov/pubmed/24668105. 

times for VA appointments or lengthy travel distances to VA medical facilities. Since the implementation of the Choice program, the 

Committee has heard an increasing number of complaints about 

the VA transplant program from veterans who are concerned about 

the lengthy travel required for many veterans to reach a VA transplant center and barriers to receiving transplant care in the community. For example, in 2016, Charles Nelson—a 100 percent service-connected veteran from Leander, Texas—attempted to receive a 

kidney transplant through the VA health care system.3 Mr. Nelson’s non-veteran son, Austin, was willing and able to serve as Mr. 

Nelson’s live donor.4 Rather than travel to VA transplant centers 

in Nashville, Tennessee, or Portland, Oregon, to receive his kidney 

transplant, Mr. Nelson asked VA to authorize him to receive his 

transplant at the University Hospital in San Antonio via the 

Choice program.5 6 Though his request was approved by local VA 

officials in Texas, VA Central Office in Washington, D.C. denied 

Mr. Nelson’s request to receive his transplant through the Choice 

program, arguing that because Austin was not a veteran VA would 

be unable to use Choice funds to cover the costs of his care.7

Though Choice is just one of several care in the community programs that VA could have used to cover the costs of Mr. Nelson’s 

transplant at the University Hospital in San Antonio, Mr. Nelson 

eventually received his transplant at that facility using his Medicare benefits, private donations, and personal savings to cover the 

cost of his care.8

On June 29, 2016, the Journal of the American Medical Association published an article which found that greater distance from a 

VA Transplant Center was associated with a lower likelihood of receiving a transplant and a greater likelihood of death among certain veteran transplant patients.9 Given the article’s findings the 

Committee believes that veterans residing far from VA transplant 

centers should be given the option of receiving their transplant 

from transplant centers in the community closer to the veteran’s 

place of residence. The Committee also believes that, wherever possible, VA should remove barriers to transplant care in the community for veteran patients. Consistent with those goals, section 2 of 

the bill would authorize VA to provide for any care or services a 

live donor may require to carry out a transplant procedure in either a VA transplant center or medical facility or VA community 

care facility for an eligible veteran notwithstanding that the live 

donor may not be eligible for VA health care. 

4 

HEARINGS

There were no Subcommittee hearings held on H.R. 1133. 

On October 24, 2017, the full Committee conducted a legislative 

hearing on a number of bills including H.R. 1133. 

The following witnesses testified: 

The Honorable Jim Banks, U.S. House of Representatives, 

3rd District, Indiana; The Honorable Mike Gallagher, U.S. 

House of Representatives, 8th District, Wisconsin; The Honorable John R. Carter, U.S. House of Representatives, 31st District, Texas; The Honorable Glenn Thompson, U.S. House of 

Representatives, 5th District, Pennsylvania; The Honorable 

Neal P. Dunn, U.S. House of Representatives, 2nd District, 

Florida; The Honorable Andy Barr, U.S. House of Representatives, 6th District, Kentucky; The Honorable David J. Shulkin, 

M.D., Secretary, U.S. Department of Veterans Affairs, who was 

accompanied by Carolyn Clancy M.D., the Executive in Charge 

of the Veterans Health Administration, and Laurie Zephyrin 

M.D., MPH, MBA, the Acting Deputy Under Secretary for 

Health for Community Care for the Veterans Health Administration; Adrian M. Atizado, Deputy National Legislative Director, Disabled American Veterans; Roscoe G. Butler, Deputy Director for Health Care, Veterans Affairs and Rehabilitation Division, The American Legion; and, Kayda Keleher, Associate 

Director, National Legislative Service, Veterans of Foreign 

Wars of the United States. 

Statements for the record were submitted by: 

American Federation of Government Employees, AFL–CIO; 

American Health Care Association; American Medical Association; AMVETS; Concerned Veterans of America; Fleet Reserve 

Association; Got Your 6; Health IT Now; Iraq and Afghanistan 

Veterans of America; Military Officers Association of America; 

Military Order of the Purple Heart; National Alliance on Mental Illness; National Guard Association of the United States; 

Nurses Organization of Veterans Affairs/Association of VA Psychologist Leaders/Association of VA Social Workers/Veterans 

Healthcare Action Campaign; Paralyzed Veterans of America; 

Reserve Officers Association; University of Pittsburgh; Vietnam Veterans of America; the Wounded Warrior Project; The 

American Congress of Obstetrics and Gynecologists; the University of California, Riverside School of Medicine; the American Society of Transplant Surgeons; and, the National Indian 

Health Board. 

SUBCOMMITTEE CONSIDERATION

There was no Subcommittee consideration of H.R. 1133, as 

amended. 

COMMITTEE CONSIDERATION

On November 2, 2017, the full Committee met in open markup 

session, a quorum being present, and ordered H.R. 1133, as amended, to be reported favorably to the House of Representatives by 

voice vote. During consideration of the bill, the following amendments were considered and agreed to by voice vote: 

5 

An Amendment in the Nature of a Substitute to H.R. 1133 

offered by Representative Brad Wenstrup of Ohio. 

COMMITTEE VOTES

In compliance with clause 3(b) of rule XIII of the Rules of the 

House of Representatives, there were no recorded votes taken on 

amendments or in connection with ordering H.R. 1133, as amended, reported to the House. A motion by Representative Tim Walz 

of Minnesota, Ranking Member of the Committee on Veterans’ Affairs, to report H.R. 1133, as amended, favorably to the House of 

Representatives was agreed to by voice vote. 

COMMITTEE OVERSIGHT FINDINGS

In compliance with clause 3(c)(1) of rule XIII and clause (2)(b)(1) 

of rule X of the Rules of the House of Representatives, the Committee’s oversight findings and recommendations are reflected in the 

descriptive portions of this report. 

STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES

In accordance with clause 3(c)(4) of rule XIII of the Rules of the 

House of Representatives, the Committee’s performance goals and 

objectives are to improve the provision of transplant care to veteran patients by authorizing VA to provide for any care or services 

a live donor may require to carry out a transplant procedure in either a VA or VA community care facility for an eligible veteran notwithstanding that the live donor may not be eligible for VA health 

care. 

NEW BUDGET AUTHORITY, ENTITLEMENT AUTHORITY, AND TAX

EXPENDITURES

With respect to the requirement with respect to clause 3(c)(2) of 

rule XIII of the Rules of the House of Representatives, the Committee has requested but not received from the Director of the Congressional Budget Office an estimate of new budget authority, entitlement authority, or tax expenditures or revenues. 

EARMARKS AND TAX AND TARIFF BENEFITS

H.R. 1133, as amended, does not contain any Congressional earmarks, limited tax benefits, or limited tariff benefits as defined in 

clause 9 of rule XXI of the Rules of the House of Representatives. 

COMMITTEE COST ESTIMATE

Clause 3(d)(2) of rule XIII of the Rules of the House of Representatives requires an estimate and a comparison by the Committee of the costs that would be incurred in carrying out this bill. 

However, clause 3(d)(3)(B) of that Rule provides that this requirement does not apply when the Committee has included in its report 

a timely submitted cost estimate of the bill prepared by the Director of the Congressional Budget Office under section 402 of the 

Congressional Budget Act of 1974. The Committee has requested 

but not received a cost estimate for this bill from the Director of 

the Congressional Budget Office. The Committee believes, according to a preliminary score from the Congressional Budget Office, 

6 

that enactment of H.R. 1133, as amended, could have significant 

discretionary costs in the tens of millions of dollars over a 5 year 

period. 

BUDGET AUTHORITY AND CONGRESSIONAL BUDGET OFFICE COST

ESTIMATE

With respect to the requirements of clause 3(c)(2) of rule XIII of 

the Rules of the House of Representatives and section 308(a) of the 

Congressional Budget Act of 1974 and with respect to requirements 

of clause (3)(c)(3) of rule XIII of the Rules of the House of Representatives and section 402 of the Congressional Budget Act of 

1974, the Committee has requested but not received a cost estimate 

for this bill from the Director of Congressional Budget Office. The 

Committee has requested but not received from the Director of the 

Congressional Budget Office a statement as to whether this bill 

contains any new budget authority, spending authority, credit authority, or an increase or decrease in revenues or tax expenditures. 

FEDERAL MANDATES STATEMENT

With respect to the requirements of Section 423 of the Congressional Budget and Impoundment Control Act (as amended by Section 101(a)(2) of the Unfunded Mandate Reform Act, P.L. 104–4), 

the Committee has requested but not received from the Director of 

the Congressional Budget Office a statement as to whether the provisions of the reported bill include unfunded mandates. 

ADVISORY COMMITTEE STATEMENT

No advisory committees within the meaning of section 5(b) of the 

Federal Advisory Committee Act would be created by H.R. 1133, as 

amended. 

STATEMENT OF CONSTITUTIONAL AUTHORITY

Pursuant to Article I, section 8 of the United States Constitution, 

H.R. 1133, as amended, is authorized by Congress’ power to ‘‘provide for the common Defense and general Welfare of the United 

States.’’ 

APPLICABILITY TO LEGISLATIVE BRANCH

The Committee finds that H.R. 1133, as amended, 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. 

STATEMENT ON DUPLICATION OF FEDERAL PROGRAMS

Pursuant to section 3(g) of H. Res. 5, 115th Cong. (2017), the 

Committee finds that no provision of H.R. 1133, as amended, establishes or reauthorizes a program of the Federal Government known 

to be duplicative of another Federal program, a program that was 

included in any report from the Government Accountability Office 

to Congress pursuant to section 21 of Public Law 111–139, or a 

program related to a program identified in the most recent Catalog 

of Federal Domestic Assistance. 

7 

DISCLOSURE OF DIRECTED RULEMAKING

Pursuant to section 3(i) of H. Res. 5, 115th Cong. (2017), the 

Committee estimates that H.R. 1133, as amended, contains no directed rulemaking that would require the Secretary to prescribe 

regulations. 

SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION

Section 1. Short title 

Section 1 of the bill would provide the short title for H.R. 1133, 

as amended, as the ‘‘Veterans Transplant Coverage Act of 2017’’. 

Section 2. Authorization to provide for operations on live donors for 

purposes on conducting transplant procedures for veterans 

Section 2(a) of the bill would amend subchapter VIII of chapter 

17 of title 38 U.S.C. by adding at the end the following new section: 

‘‘§ 1788. Transplant procedures with live donors and related services.’’ The new section 1788 (a) would authorize VA, in the case in 

which a veteran is eligible for a transplant procedure from VA, to 

provide for an operation on a live donor to carry out the transplant 

procedure for the eligible veteran notwithstanding that the live 

donor may not be eligible for health care from VA. The new section 

1788 (b) would require VA, subject to the availability of appropriations for such purpose, to furnish to a live donor any care or services before or after conducting the transplant procedure under section 1788(a) that may be required in connection with such procedure. The new section 1788(c) would authorize VA to provide for 

the operation described in section 1788(a) on a live donor and furnish to the live donor the care and services described in section 

1788(b) pursuant to an agreement entered into by VA under section 1703 or 8153 of title 38 U.S.C., section 101 of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113–146; 

38 U.S.C. 1701 note), or any other authority to provide to furnish 

care at non-VA facilities. The new section 1788(c) would also require the live donor to be deemed an individual eligible for hospital 

care and medical services at a non-VA facility pursuant to such an 

agreement solely for the purposes of receiving such operation, care, 

and services at a non-VA facility. 

Section 2(b) of the bill would amend the table of sections at the 

beginning of chapter 17 of title 38 U.S.C. by inserting after the 

item relating to section 1787 the following new item: 1788. Transplant procedures with live donors and related services.’’. 

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 (new matter is printed in italic 

and existing law in which no change is proposed is shown in 

roman): 

TITLE 38, UNITED STATES CODE 

* * * * * * * 

8 

PART II—GENERAL BENEFITS 

* * * * * * * 

CHAPTER 17—HOSPITAL, NURSING HOME, 

DOMICILIARY, AND MEDICAL CARE 

SUBCHAPTER I—GENERAL 

Sec. 

1701. Definitions. 

* * * * * * * 

1788. Transplant procedures with live donors and related services. 

* * * * * * * 

SUBCHAPTER VIII—HEALTH CARE OF PERSONS OTHER 

THAN VETERANS 

* * * * * * * 

§ 1788. Transplant procedures with live donors and related 

services 

(a) IN GENERAL.—In a case in which a veteran is eligible for a 

transplant procedure from the Department, the Secretary may provide for an operation on a live donor to carry out such procedure 

for such veteran, notwithstanding that the live donor may not be eligible for health care from the Department. 

(b) OTHER SERVICES.—Subject to the availability of appropriations for such purpose, the Secretary shall furnish to a live donor 

any care or services before and after conducting the transplant procedure under subsection (a) that may be required in connection with 

such procedure. 

(c) USE OF DEPARTMENT OR NON-DEPARTMENT FACILITIES.—The 

Secretary may provide for the operation described in subsection (a) 

on a live donor and furnish to the live donor the care and services 

described in subsection (b) at a facility of the Department or at a 

non-Department facility pursuant to an agreement entered into by 

the Secretary under section 1703 or 8153 of this title, section 101 

of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113–146; 38 U.S.C. 1701 note), or any other authority of the 

Secretary to furnish care at non-Department facilities. The live 

donor shall be deemed to be an individual eligible for hospital care 

and medical services at a non-Department facility pursuant to such 

an agreement solely for the purposes of receiving such operation, 

care, and services at the non-Department facility. 

* * * * * * * 

Æ