19–006

108TH CONGRESS REPORT " HOUSE OF REPRESENTATIVES ! 1st Session 108–15

ORGAN DONATION IMPROVEMENT ACT OF 2003

FEBRUARY 13, 2003.—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. 399] 

[Including cost estimate of the Congressional Budget Office]

The Committee on Energy and Commerce, to whom was referred 

the bill (H.R. 399) 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 ................................................................................................................... 2

Committee Consideration ........................................................................................ 2

Committee Votes ...................................................................................................... 2

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 ................................................................................. 4

Advisory Committee Statement .............................................................................. 4

Constitutional Authority Statement ...................................................................... 4

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

The purpose of H.R. 399, the Organ Donation Improvement Act 

of 2003, is to create new incentives for people to become organ donors and provides for studies and demonstration projects to encourage organ donation education efforts across the country. 

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BACKGROUND AND NEED FOR LEGISLATION

Medical advances and the generosity of organ and tissue donors 

enable more than 22,000 Americans per year to receive organ 

transplants that save or enhance their lives. Despite the self-sacrifice and charity of these donors, this is only a small proportion 

of the more than 76,000 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). As a result, about 5,500 people die in the United States each year (or 15 patients each day) 

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. 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. 

H.R. 399 accomplishes this objective by permitting the Secretary 

of the Department of Health and Human Services (HHS) to make 

awards of grants or contracts to States, transplant centers, qualified organ procurement organizations, or other public or private entities for the purposes 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. 

HEARINGS

The Committee on Energy and Commerce has not held hearings 

on the legislation. 

COMMITTEE CONSIDERATION

On Wednesday, January 29, 2003, the Full Committee on Energy 

and Commerce met in open markup session and ordered H.R. 399 

favorably reported to the House, without amendment, by a voice 

vote, a quorum being present. 

COMMITTEE VOTES

There were no record votes taken in connection with ordering 

H.R. 399 reported. A motion by Mr. Tauzin to order H.R. 399 reVerDate Jan 31 2003 18:31 Feb 19, 2003 Jkt 019006 PO 00000 Frm 00002 Fmt 6659 Sfmt 6602 E:\HR\OC\HR015.XXX HR015
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ported to the House, without amendment, was agreed to by a voice 

vote. 

COMMITTEE OVERSIGHT FINDING

Pursuant to clause 3(c)(1) of rule XIII of the Rules of the House 

of Representatives, the Committee has not held oversight or legislative hearings on this legislation. 

STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES

The goal of H.R. 399 is to 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. 399, the 

‘‘Organ Donation Improvement Act of 2003’’, 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, February 10, 2003. 

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. 399, the Organ Donation 

Improvement Act of 2003. 

If you wish further details on this estimate, we will be pleased 

to provide them. The CBO staff contact is Margaret Nowak. 

Sincerely, 

DOUGLAS HOLTZ-EAKIN, Director. 

Enclosure.

H.R. 399—Organ Donation Improvement Act of 2003

H.R. 399 would amend the Public Health Service Act to promote 

organ donation. The bill would authorize the appropriation of $5 

million a year in 2004 through 2008 for travel and subsistence expenses for qualifying individuals who make a living donation of 

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their organs. H.R. 399 would also authorize the appropriation of 

$15 million in fiscal year 2004 for a program to increase public 

awareness of organ donation and for studies and demonstrations 

designed to increase the rate of organ donation. It would authorize 

such sums as may be necessary for this program from 2005 

through 2008. 

CBO estimates that implementing H.R. 399 would cost $6 million 

in 2004 and a total of $79 million from 2004 through 2008, without 

adjusting for inflation, and $81 million if inflation adjustments are 

included, assuming appropriation of the necessary amounts. The 

legislation would not affect direct spending or receipts. 

The estimated budgetary of H.R. 399 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 purses 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. 399 contains no intergovernmental or private-sector 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—

2003 2004 2005 2006 2007 2008

CHANGES IN SPENDING SUBJECT TO APPROPRIATION

Without Adjustments for Inflation

Estimated authorization level ...................................................... 0 20 20 20 20 20

Estimated outlays ......................................................................... 0 6 15 18 20 20

Without Adjustments for Inflation

Estimated authorization level ...................................................... 0 20 20 21 21 21

Estimated outlays ......................................................................... 0 6 15 19 20 21

The CBO staff contact is Margaret Nowak. 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. 

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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 2003.’’

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. 399 authorizes a grant program to the 

separate states to increase organ donation, which could establish 

their own travel and subsistence programs, 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. 

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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 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

* * * * * * *

øSEC. 377. STUDY BY GENERAL ACCOUNTING OFFICE. 

ø(a) IN GENERAL.—The Comptroller General of the United States 

shall conduct a study for the purpose of determining— ø(1) the extent to which the procurement and allocation of 

organs have been equitable, efficient, and effective; 

ø(2) the problems encountered in the procurement and allocation; and 

ø(3) the effect of State required-request laws. 

ø(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 

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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 

2004 and subsequent fiscal years to offset the effects of inflation occurring after the beginning of fiscal year 2003). 

(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—

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(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 2004 through 2008. 

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, tissue banks, eye banks, 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 

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.—

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(1) IN GENERAL.—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. 

(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). 

* * * * * * *

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