I 

117TH CONGRESS 

1ST SESSION H. R. 1235 

To prohibit discrimination on the basis of mental or physical disability in 

cases of anatomical gifts and organ transplants. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 23, 2021 

Ms. HERRERA BEUTLER (for herself and Ms. PORTER) introduced the 

following bill; which was referred to the Committee on Energy and Commerce 

A BILL 

To prohibit discrimination on the basis of mental or physical 

disability in cases of anatomical gifts and organ transplants. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Charlotte Woodward 

5 Organ Transplant Discrimination Prevention Act’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds as follows: 

8 (1) The Americans with Disabilities Act, section 

9 504 of the Rehabilitation Act of 1973, and section 

10 1557 of the Patient Protection and Affordable Care 


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1 Act (ACA) prohibit discrimination against individ2 uals with disabilities in organ transplantation and 

3 the rationing of organs. 

4 (2) Despite these protections, there are findings 

5 and cases that show that individuals with disabilities 

6 are being denied organ transplants and related serv7 ices solely based on the fact that they have a dis8 ability, as is documented by the National Council on 

9 Disability and others. 

10 (3) Sixteen States have crafted state level policy 

11 to prohibit organ transplant discrimination against 

12 individuals with disabilities, however, Federal action 

13 is required to protect Americans with disabilities and 

14 to enforce existing law regardless of the state in 

15 which they live. 

16 (4) Continuing cases of discrimination against 

17 individuals with disabilities calls for further clarity 

18 by Congress to which actions constitute discrimina19 tion within the existing legal context, which entities 

20 are covered, and the remedies available to individ21 uals experiencing potential discrimination. 

22 (5) Licensed providers of health care services 

23 who perform organ transplants and related services 

24 in exchange for medical fees are engaging in an ecoVerDate Sep 11 2014 23:01 Mar 20, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H1235.IH H1235

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1 nomic transaction with patients that occurs in or 

2 substantially impacts interstate commerce. 

3 (6) There are 11 geographic regions that are 

4 used for U.S. organ allocation with organs being 

5 transported across state lines for transplantation 

6 procedures. 

7 (7) Discrimination in organ transplantation 

8 limits individuals with disabilities from participating 

9 in a manner that allows equal access to interstate 

10 commerce. 

11 (8) The existence of arbitrary discrimination 

12 against individuals with disabilities in organ trans13 plantation and related services burdens the flow of 

14 organs through legal channels of interstate com15 merce. 

16 (9) Congress is empowered to regulate and pro17 tect the instrumentalities of interstate commerce, 

18 persons, or things in interstate commerce, even 

19 though the threat may come only from intrastate ac20 tivities. 

21 (10) Congress’ commerce authority includes the 

22 power to regulate those activities having substantial 

23 relation to interstate commerce and activities that 

24 substantially affect interstate commerce. 


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1 (11) Nothing in this bill shall be construed to 

2 limit or replace the scope of obligations imposed by 

3 the Americans with Disabilities Act, section 504 of 

4 the Rehabilitation Act of 1973, section 1557 of the 

5 Affordable Care Act, or any other applicable law. 

6 SEC. 3. DEFINITIONS. 

7 For purposes of this Act: 

8 (1) ANATOMICAL GIFT.—The term ‘‘anatomical 

9 gift’’ means a donation of all or part of a human 

10 body that takes effect after the death of the donor 

11 for the purpose of transplantation or transfusion. 

12 (2) AUXILIARY AIDS AND SERVICES.—The term 

13 ‘‘auxiliary aids and services’’ includes— 

14 (A) qualified interpreters or other effective 

15 methods of making aurally delivered materials 

16 available to individuals with hearing impair17 ments; 

18 (B) qualified readers, taped texts, or other 

19 effective methods of making visually delivered 

20 materials available to individuals with visual im21 pairments; 

22 (C) provision of information in a format 

23 that is accessible for individuals with cognitive, 

24 neurological, developmental, or intellectual dis25 abilities; 


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1 (D) provision of supported decision-making 

2 services; and 

3 (E) acquisition or modification of equip4 ment or devices. 

5 (3) COVERED ENTITY.—The term ‘‘covered en6 tity’’ means— 

7 (A) any licensed provider of health care 

8 services, including licensed health care practi9 tioners, hospitals, nursing facilities, labora10 tories, intermediate care facilities, psychiatric 

11 residential treatment facilities, institutions for 

12 individuals with intellectual or developmental 

13 disabilities, and prison health centers; or 

14 (B) any entity responsible for matching 

15 anatomical gift donors to potential recipients. 

16 (4) DISABILITY.—The term ‘‘disability’’ has the 

17 same meaning give such term in section 4 of the 

18 Americans with Disabilities Act of 1990. 

19 (5) ORGAN TRANSPLANT.—The term ‘‘organ 

20 transplant’’ means the transplantation or trans21 fusion of a part of a human body into the body of 

22 another for the purpose of treating or curing a med23 ical condition. 

24 (6) QUALIFIED INDIVIDUAL.—The term ‘‘quali25 fied individual’’ means an individual who, with or 


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1 without a support network, provision of auxiliary 

2 aids and services, or reasonable modifications to 

3 policies or practices, meets eligibility requirements 

4 for the receipt of an anatomical gift. 

5 (7) REASONABLE MODIFICATIONS TO POLICIES

6 OR PRACTICES.—The term ‘‘reasonable modifications 

7 to policies or practices’’ include— 

8 (A) communication with individuals re9 sponsible for supporting an individual with 

10 postsurgical and post-transplantation care, in11 cluding medication; and 

12 (B) consideration of support networks 

13 available to the individual, including family, 

14 friends, and home and community-based serv15 ices, including home and community-based serv16 ices funded through medicaid, medicare, an17 other health plan in which the individual is en18 rolled, or any program or source of funding 

19 available to the individual, in determining 

20 whether the individual is able to comply with 

21 posttransplant medical requirements. 

22 (8) SECRETARY.—The term ‘‘Secretary’’ means 

23 the Secretary of Health and Human Services. 

24 (9) SUPPORTED DECISION MAKING.—The term 

25 ‘‘supported decision making’’ means the use of a 


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1 support person to assist an individual in making 

2 medical decisions, communicate information to the 

3 individual, or ascertain an individual’s wishes. Such 

4 term may include— 

5 (A) the inclusion of the individual’s attor6 ney-in-fact, health care proxy, or any person of 

7 the individual’s choice in communications about 

8 the individual’s medical care; 

9 (B) permitting the individual to designate 

10 a person of their choice for the purposes of sup11 porting that individual in communicating, proc12 essing information, or making medical deci13 sions; 

14 (C) providing auxiliary aids and services to 

15 facilitate the individual’s ability to communicate 

16 and process health-related information, includ17 ing use of assistive communication technology; 

18 (D) providing information to persons des19 ignated by the individual, consistent with the 

20 provisions of the Health Insurance Portability 

21 and Accountability Act of 1996, (4 U.S.C. 13 

22 et seq.), and other applicable laws and regula23 tions governing disclosure of health informa24 tion; 


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1 (E) providing health information in a for2 mat that is readily understandable by the indi3 vidual; and 

4 (F) working with a court-appointed guard5 ian or other individual responsible for making 

6 medical decisions on behalf of the individual, to 

7 ensure that the individual is included in deci8 sions involving the health care of the individual 

9 and that medical decisions are in accordance 

10 with the individual’s own expressed interests. 

11 (10) SUPPORT NETWORK.—The term ‘‘support 

12 network’’ means, with respect to a person, one or 

13 more individuals selected by the person or by the 

14 person and the guardian of the person, to provide 

15 assistance to that person or guidance to that person 

16 in understanding issues, making plans for the fu17 ture, or making complex decisions, including the per18 son’s family, friends, unpaid supporters, religious 

19 congregations, and community centers. 

20 SEC. 4. PROHIBITION OF DISCRIMINATION. 

21 (a) IN GENERAL.—Subject to subsection (b), a cov22 ered entity may not, solely on the basis of a qualified indi23 vidual’s mental or physical disability— 

24 (1) deem such individual ineligible to receive an 

25 anatomical gift or organ transplant; 


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1 (2) deny such individual medical or related 

2 organ transplantation services, including evaluation, 

3 surgery, counseling, and postoperative treatment and 

4 care; 

5 (3) refuse to refer the individual to a transplant 

6 center or other related specialist for the purpose of 

7 evaluation or receipt of an organ transplant; 

8 (4) refuse to place an individual on an organ 

9 transplant waiting list, or placement of the indi10 vidual at a lower-priority position on the list than 

11 the position at which the individual would have been 

12 placed if not for the disability of the individual; or 

13 (5) decline insurance coverage for such indi14 vidual for any procedure associated with the receipt 

15 of an anatomical gift, including post-transplantation 

16 care if such procedure would be covered under such 

17 coverage for such individual if not for the disability 

18 of the individual. 

19 (b) EXCEPTION.— 

20 (1) IN GENERAL.—Notwithstanding subsection 

21 (a), a covered entity may take an individual’s dis22 ability into account when making treatment or cov23 erage recommendations or decisions, solely to the ex24 tent that the physical or mental disability has been 

25 found by a physician, following an individualized 


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1 evaluation of the potential recipient, to be medically 

2 significant to the provision of the anatomical gift. 

3 The previous sentence shall not be treated as requir4 ing referrals or recommendations for, or the per5 formance of, medically inappropriate organ trans6 plants. 

7 (2) CLARIFICATION.—If an individual has the 

8 necessary support system to provide reasonable as9 surance that the individual will comply with 

10 posttransplant medical requirements, the individual’s 

11 inability to independently comply with those require12 ments may not be deemed to be medically significant 

13 for purposes of paragraph (1). 

14 (c) REASONABLE MODIFICATIONS.—A covered entity 

15 shall make reasonable modifications to policies, practices, 

16 or procedures of such entity if such modifications are nec17 essary to make services such as transplantation-related 

18 counseling, information, coverage, or treatment available 

19 to qualified individuals with disabilities, unless the entity 

20 can demonstrate that making such modifications would 

21 fundamentally alter the nature of such services. 

22 (d) CLARIFICATIONS.— 

23 (1) A covered entity shall take such steps as 

24 may be necessary to ensure that no qualified indi25 vidual with a disability is denied services such as 


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1 transplantation-related counseling, information, cov2 erage, or treatment because of the absence of auxil3 iary aids and services, unless the entity can dem4 onstrate that taking such steps would fundamentally 

5 alter the nature of the services being offered or 

6 would result in an undue burden. 

7 (2) A covered entity shall otherwise comply with 

8 the requirements of titles II and III of the Ameri9 cans with Disabilities Act of 1990 and the Ameri10 cans with Disabilities Act Amendments Act of 2008. 

11 (3) The provisions of this section apply to each 

12 part of the organ transplant process. 

13 SEC. 5. ENFORCEMENT. 

14 (a) IN GENERAL.—Any individual with a claim, with 

15 respect to a covered entity, to be (or to have been) subject 

16 to discrimination in violation of section 3— 

17 (1) may bring such a claim to the Office for 

18 Civil Rights of the Department of Health and 

19 Human Services for expedited resolution; and 

20 (2) whether or not such a claim is brought 

21 under paragraph (1) or a violation is found pursuant 

22 to paragraph (1), may bring a civil action before the 

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1 section (b), against such covered entity to enforce 

2 compliance of such covered entity with such section. 

3 (b) RELIEF AVAILABLE.—The injunctive and equi4 table relief available in a civil action brought under sub5 section (a)(2), with respect to a covered entity, includes— 

6 (1) requiring auxiliary aids or services to be 

7 made available by such entity; 

8 (2) requiring the modification of a policy, prac9 tice, or procedure of such entity; or 

10 (3) requiring facilities of such entity be made 

11 readily accessible and usable. 

12 (c) EXPEDITED REVIEW.—In the case of a civil ac13 tion brought under subsection (a)(2), with respect to a 

14 covered entity, the Federal court before which such action 

15 is brought shall advance on its docket and expedite review 

16 and disposition of such action. 

17 (d) RULE OF CONSTRUCTION.—Nothing in this sec18 tion is intended to limit or replace available remedies 

19 under the Americans with Disabilities Act of 1990 and 

20 the Americans with Disabilities Act Amendments Act of 

21 2008 or any other applicable law. 

Æ 


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