```

[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[S. 1597 Reported in Senate (RS)]

                                                       Calendar No. 378

103d CONGRESS

  2d Session

                                S. 1597

                          [Report No. 103-233]

_______________________________________________________________________

                                 A BILL

  To amend the Public Health Service Act to revise and extend certain 
organ procurement and transplantation programs, and for other purposes.

_______________________________________________________________________

              March 7 (legislative day, February 22), 1994

                       Reported with an amendment

                                                       Calendar No. 378
103d CONGRESS
  2d Session
                                S. 1597

  To amend the Public Health Service Act to revise and extend certain 
organ procurement and transplantation programs, and for other purposes.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

             October 27 (legislative day, October 13), 1993

  Mr. Kennedy introduced the following bill; which was read twice and 
         referred to the Committee on Labor and Human Resources

              March 7 (legislative day, February 22), 1994

               Reported by Mr. Kennedy, with an amendment
 [Strike out all after the enacting clause and insert the part printed 
                               in italic]

_______________________________________________________________________

                                 A BILL

 
  To amend the Public Health Service Act to revise and extend certain 
organ procurement and transplantation programs, and for other purposes.

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

-S-E-C-T-I-O-N -1-. -S-H-O-R-T -T-I-T-L-E-.

    -T-h-i-s -A-c-t -m-a-y -b-e -c-i-t-e-d -a-s -t-h-e -`-`-O-r-g-a-n 
-T-r-a-n-s-p-l-a-n-t -P-r-o-g-r-a-m -R-e-a-u-t-h-o-r-i-z-a-t-i-o-n 
-A-c-t -o-f -1-9-9-3-'-'-.

-S-E-C-. -2-. -O-R-G-A-N -P-R-O-C-U-R-E-M-E-N-T 
              -O-R-G-A-N-I-Z-A-T-I-O-N-S-.

    -(-a-) -I-n -G-e-n-e-r-a-l-.----S-u-b-s-e-c-t-i-o-n -(-a-) -o-f 
-s-e-c-t-i-o-n -3-7-1 -o-f -t-h-e -P-u-b-l-i-c -H-e-a-l-t-h 
-S-e-r-v-i-c-e -A-c-t -(-4-2 -U-.-S-.-C-. -2-7-3-(-a-)-) -i-s 
-a-m-e-n-d-e-d -t-o -r-e-a-d -a-s -f-o-l-l-o-w-s-:
    -`-`-(-a-)-(-1-) -T-h-e -S-e-c-r-e-t-a-r-y -m-a-y -m-a-k-e 
-g-r-a-n-t-s -f-o-r -t-h-e -c-o-n-s-o-l-i-d-a-t-i-o-n -a-n-d 
-e-x-p-a-n-s-i-o-n -o-f -q-u-a-l-i-f-i-e-d -o-r-g-a-n 
-p-r-o-c-u-r-e-m-e-n-t -o-r-g-a-n-i-z-a-t-i-o-n-s -d-e-s-c-r-i-b-e-d 
-i-n -s-u-b-s-e-c-t-i-o-n -(-b-)-.
    -`-`-(-2-) -T-h-e -S-e-c-r-e-t-a-r-y -m-a-y -m-a-k-e -g-r-a-n-t-s 
-t-o-, -a-n-d -e-n-t-e-r -i-n-t-o -c-o-o-p-e-r-a-t-i-v-e 
-a-g-r-e-e-m-e-n-t-s -a-n-d -c-o-n-t-r-a-c-t-s -w-i-t-h-, 
-q-u-a-l-i-f-i-e-d -o-r-g-a-n -p-r-o-c-u-r-e-m-e-n-t 
-o-r-g-a-n-i-z-a-t-i-o-n-s -d-e-s-c-r-i-b-e-d -i-n -s-u-b-s-e-c-t-i-o-n 
-(-b-) -a-n-d -o-t-h-e-r -p-u-b-l-i-c -o-r -n-o-n-p-r-o-f-i-t 
-p-r-i-v-a-t-e -e-n-t-i-t-i-e-s -f-o-r -t-h-e -p-u-r-p-o-s-e -o-f 
-i-n-c-r-e-a-s-i-n-g -o-r-g-a-n -d-o-n-a-t-i-o-n -t-h-r-o-u-g-h---
            -`-`-(-A-) -t-h-e -p-l-a-n-n-i-n-g -a-n-d 
        -c-o-n-d-u-c-t-i-n-g -o-f -p-r-o-g-r-a-m-s -t-o -p-r-o-v-i-d-e 
        -i-n-f-o-r-m-a-t-i-o-n -a-n-d -e-d-u-c-a-t-i-o-n -t-o -t-h-e 
        -p-u-b-l-i-c -o-n -t-h-e -n-e-e-d -f-o-r -o-r-g-a-n 
        -d-o-n-a-t-i-o-n-s-;
            -`-`-(-B-) -t-h-e -t-r-a-i-n-i-n-g -o-f 
        -i-n-d-i-v-i-d-u-a-l-s -i-n -r-e-q-u-e-s-t-i-n-g -s-u-c-h 
        -d-o-n-a-t-i-o-n-s-; -o-r
            -`-`-(-C-) -t-h-e -p-r-o-v-i-s-i-o-n -o-f 
        -t-e-c-h-n-i-c-a-l -a-s-s-i-s-t-a-n-c-e -t-o -o-r-g-a-n 
        -p-r-o-c-u-r-e-m-e-n-t -o-r-g-a-n-i-z-a-t-i-o-n-s -a-n-d 
        -o-t-h-e-r -e-n-t-i-t-i-e-s -i-n -t-h-e -h-e-a-l-t-h -c-a-r-e 
        -s-y-s-t-e-m-.
    -`-`-(-3-)-(-A-) -I-n -m-a-k-i-n-g -a-w-a-r-d-s -o-f -g-r-a-n-t-s-, 
-c-o-o-p-e-r-a-t-i-v-e -a-g-r-e-e-m-e-n-t-s -a-n-d -c-o-n-t-r-a-c-t-s 
-u-n-d-e-r -s-u-b-p-a-r-a-g-r-a-p-h-s -(-A-) -a-n-d -(-B-) -o-f 
-p-a-r-a-g-r-a-p-h -(-2-)-, -t-h-e -S-e-c-r-e-t-a-r-y -s-h-a-l-l 
-g-i-v-e -p-r-i-o-r-i-t-y -t-o -c-a-r-r-y-i-n-g -o-u-t -t-h-e 
-p-u-r-p-o-s-e -d-e-s-c-r-i-b-e-d -i-n -s-u-c-h -p-a-r-a-g-r-a-p-h 
-w-i-t-h -r-e-s-p-e-c-t -t-o -m-i-n-o-r-i-t-y -o-r -o-t-h-e-r 
-p-o-p-u-l-a-t-i-o-n-s -f-o-r -w-h-i-c-h -t-h-e-r-e -i-s -a 
-g-r-e-a-t-e-r -d-e-g-r-e-e -o-f -o-r-g-a-n -s-h-o-r-t-a-g-e-s 
-r-e-l-a-t-i-v-e -t-o -t-h-e -g-e-n-e-r-a-l -p-o-p-u-l-a-t-i-o-n-.
    -`-`-(-B-) -I-n -m-a-k-i-n-g -a-w-a-r-d-s -o-f -g-r-a-n-t-s-, 
-c-o-o-p-e-r-a-t-i-v-e -a-g-r-e-e-m-e-n-t-s -a-n-d -c-o-n-t-r-a-c-t-s 
-u-n-d-e-r -p-a-r-a-g-r-a-p-h -(-2-)-(-C-)-, -t-h-e -S-e-c-r-e-t-a-r-y 
-s-h-a-l-l -g-i-v-e -p-r-i-o-r-i-t-y -t-o -c-a-r-r-y-i-n-g -o-u-t 
-t-h-e -p-u-r-p-o-s-e -d-e-s-c-r-i-b-e-d -i-n -s-u-c-h 
-p-a-r-a-g-r-a-p-h -w-i-t-h -r-e-s-p-e-c-t -t-o -o-r-g-a-n 
-p-r-o-c-u-r-e-m-e-n-t -o-r-g-a-n-i-z-a-t-i-o-n-s -a-n-d 
-h-o-s-p-i-t-a-l-s -w-i-t-h -l-o-w-e-r -r-a-t-e-s -o-f 
-p-r-o-c-u-r-e-m-e-n-t -r-e-l-a-t-i-v-e -t-o -o-t-h-e-r -s-u-c-h 
-o-r-g-a-n-i-z-a-t-i-o-n-s -o-r -h-o-s-p-i-t-a-l-s-.-'-'-.
    -(-b-) -Q-u-a-l-i-f-i-e-d -O-r-g-a-n -P-r-o-c-u-r-e-m-e-n-t 
-O-r-g-a-n-i-z-a-t-i-o-n-s-.----S-e-c-t-i-o-n -3-7-1-(-b-) -o-f 
-s-u-c-h -A-c-t -(-4-2 -U-.-S-.-C-. -2-7-3-(-b-)-) -i-s 
-a-m-e-n-d-e-d---
            -(-1-) -i-n -p-a-r-a-g-r-a-p-h -(-1-)---
                    -(-A-) -i-n -t-h-e -m-a-t-t-e-r -p-r-e-c-e-d-i-n-g 
                -s-u-b-p-a-r-a-g-r-a-p-h -(-A-)-, -b-y -s-t-r-i-k-i-n-g 
                -`-`-f-o-r -w-h-i-c-h -g-r-a-n-t-s -m-a-y -b-e -m-a-d-e 
                -u-n-d-e-r -s-u-b-s-e-c-t-i-o-n -(-a-)-'-' -a-n-d 
                -i-n-s-e-r-t-i-n-g -`-`-d-e-s-c-r-i-b-e-d -i-n -t-h-i-s 
                -s-e-c-t-i-o-n-'-'-;
                    -(-B-) -b-y -r-e-a-l-i-g-n-i-n-g -t-h-e 
                -m-a-r-g-i-n -o-f -s-u-b-p-a-r-a-g-r-a-p-h -(-E-) -s-o 
                -a-s -t-o -a-l-i-g-n -w-i-t-h -t-h-e -m-a-r-g-i-n -o-f 
                -s-u-b-p-a-r-a-g-r-a-p-h -(-D-)-; -a-n-d
                    -(-C-) -i-n -s-u-b-p-a-r-a-g-r-a-p-h -(-G-)---
                            -(-i-) -i-n -t-h-e -m-a-t-t-e-r 
                        -p-r-e-c-e-d-i-n-g -c-l-a-u-s-e -(-i-)-, -b-y 
                        -s-t-r-i-k-i-n-g -`-`-d-i-r-e-c-t-o-r-s -o-r 
                        -a-n -a-d-v-i-s-o-r-y -b-o-a-r-d-'-' -a-n-d 
                        -i-n-s-e-r-t-i-n-g -`-`-d-i-r-e-c-t-o-r-s 
                        -(-o-r -a-n -a-d-v-i-s-o-r-y -b-o-a-r-d-, -i-n 
                        -t-h-e -c-a-s-e -o-f -a -h-o-s-p-i-t-a-l--
                        -b-a-s-e-d -o-r-g-a-n -p-r-o-c-u-r-e-m-e-n-t 
                        -o-r-g-a-n-i-z-a-t-i-o-n -e-s-t-a-b-l-i-s-h-e-d 
                        -p-r-i-o-r -t-o -S-e-p-t-e-m-b-e-r -1-, 
                        -1-9-9-3-)-'-'-; -a-n-d
                            -(-i-i-) -i-n -c-l-a-u-s-e -(-i-)---
                                    -(-I-) -b-y -s-t-r-i-k-i-n-g 
                                -`-`-c-o-m-p-o-s-e-d -o-f-'-' -i-n 
                                -t-h-e -m-a-t-t-e-r -p-r-e-c-e-d-i-n-g 
                                -s-u-b-c-l-a-u-s-e -(-I-) -a-n-d 
                                -i-n-s-e-r-t-i-n-g -`-`-c-o-m-p-o-s-e-d 
                                -o-f -a -r-e-a-s-o-n-a-b-l-e 
                                -b-a-l-a-n-c-e -o-f-'-'-; -a-n-d
                                    -(-I-I-) -b-y -i-n-s-e-r-t-i-n-g 
                                -b-e-f-o-r-e -t-h-e -c-o-m-m-a -i-n 
                                -s-u-b-c-l-a-u-s-e -(-I-I-) -t-h-e 
                                -f-o-l-l-o-w-i-n-g-: -`-`-, 
                                -i-n-c-l-u-d-i-n-g 
                                -i-n-d-i-v-i-d-u-a-l-s -w-h-o -h-a-v-e 
                                -r-e-c-e-i-v-e-d -a 
                                -t-r-a-n-s-p-l-a-n-t -o-f -a-n 
                                -o-r-g-a-n -(-o-r -t-r-a-n-s-p-l-a-n-t 
                                -c-a-n-d-i-d-a-t-e-s-)-, -a-n-d 
                                -i-n-d-i-v-i-d-u-a-l-s -w-h-o -a-r-e 
                                -p-a-r-t -o-f -t-h-e -f-a-m-i-l-y -o-f 
                                -a-n -i-n-d-i-v-i-d-u-a-l -w-h-o -h-a-s 
                                -d-o-n-a-t-e-d -a-n -o-r-g-a-n-'-'-;
            -(-2-) -b-y -s-t-r-i-k-i-n-g -p-a-r-a-g-r-a-p-h -(-2-)-;
            -(-3-) -b-y -r-e-d-e-s-i-g-n-a-t-i-n-g -p-a-r-a-g-r-a-p-h 
        -(-3-) -a-s -p-a-r-a-g-r-a-p-h -(-2-)-;
            -(-4-) -i-n -p-a-r-a-g-r-a-p-h -(-2-) -(-a-s -s-o 
        -r-e-d-e-s-i-g-n-a-t-e-d-)---
                    -(-A-) -b-y -s-t-r-i-k-i-n-g 
                -s-u-b-p-a-r-a-g-r-a-p-h -(-A-) -a-n-d 
                -i-n-s-e-r-t-i-n-g -t-h-e -f-o-l-l-o-w-i-n-g -n-e-w 
                -s-u-b-p-a-r-a-g-r-a-p-h-:
            -`-`-(-A-) -w-i-t-h -r-e-s-p-e-c-t -t-o -e-a-c-h 
        -h-o-s-p-i-t-a-l -o-r -o-t-h-e-r -e-n-t-i-t-y -i-n -i-t-s 
        -s-e-r-v-i-c-e -a-r-e-a -t-h-a-t -h-a-s -f-a-c-i-l-i-t-i-e-s 
        -f-o-r -o-r-g-a-n -d-o-n-a-t-i-o-n-s-, -a-n-d -e-x-c-e-p-t -a-s 
        -p-r-o-v-i-d-e-d -i-n -p-a-r-a-g-r-a-p-h -(-3-)---
                    -`-`-(-i-) -h-a-v-e -i-n -e-f-f-e-c-t -a-n 
                -a-g-r-e-e-m-e-n-t -w-i-t-h -t-h-e -e-n-t-i-t-y 
                -u-n-d-e-r -w-h-i-c-h -t-h-e -e-n-t-i-t-y-, -f-o-r 
                -t-h-e -p-u-r-p-o-s-e-s -o-f -a-l-l-o-c-a-t-i-o-n-, 
                -i-d-e-n-t-i-f-i-e-s -p-o-t-e-n-t-i-a-l -o-r-g-a-n 
                -d-o-n-o-r-s -a-n-d -n-o-t-i-f-i-e-s -t-h-e -o-r-g-a-n 
                -p-r-o-c-u-r-e-m-e-n-t -o-r-g-a-n-i-z-a-t-i-o-n-, 
                -a-n-d
                    -`-`-(-i-i-) -i-f -s-u-c-h -h-o-s-p-i-t-a-l -o-r 
                -e-n-t-i-t-y -i-s -d-i-s-s-a-t-i-s-f-i-e-d -w-i-t-h 
                -t-h-e -s-e-r-v-i-c-e -o-b-t-a-i-n-e-d -f-r-o-m -i-t-s 
                -d-e-s-i-g-n-a-t-e-d -o-r-g-a-n -p-r-o-c-u-r-e-m-e-n-t 
                -o-r-g-a-n-i-z-a-t-i-o-n -s-u-c-h -h-o-s-p-i-t-a-l -o-r 
                -e-n-t-i-t-y -m-a-y -s-e-e-k -m-e-d-i-a-t-i-o-n 
                -u-n-d-e-r -a -p-r-o-c-e-s-s -e-s-t-a-b-l-i-s-h-e-d 
                -b-y -t-h-e -S-e-c-r-e-t-a-r-y -w-i-t-h-i-n -6-0 
                -d-a-y-s -a-f-t-e-r -t-h-e -d-a-t-e -o-f 
                -e-n-a-c-t-m-e-n-t -o-f -t-h-i-s 
                -s-u-b-p-a-r-a-g-r-a-p-h-,-'-'-;
                    -(-B-) -b-y -r-e-d-e-s-i-g-n-a-t-i-n-g 
                -s-u-b-p-a-r-a-g-r-a-p-h-s -(-B-) -t-h-r-o-u-g-h -(-K-) 
                -a-s -s-u-b-p-a-r-a-g-r-a-p-h-s -(-C-) -t-h-r-o-u-g-h 
                -(-L-)-, -r-e-s-p-e-c-t-i-v-e-l-y-;
                    -(-C-) -b-y -i-n-s-e-r-t-i-n-g -a-f-t-e-r 
                -s-u-b-p-a-r-a-g-r-a-p-h -(-A-) -t-h-e 
                -f-o-l-l-o-w-i-n-g -n-e-w -s-u-b-p-a-r-a-g-r-a-p-h-:
            -`-`-(-B-) -c-o-n-d-u-c-t -a-n-d -p-a-r-t-i-c-i-p-a-t-e 
        -i-n -s-y-s-t-e-m-a-t-i-c -e-f-f-o-r-t-s-, -i-n-c-l-u-d-i-n-g 
        -p-u-b-l-i-c -e-d-u-c-a-t-i-o-n-, -t-o -i-n-c-r-e-a-s-e -t-h-e 
        -n-u-m-b-e-r -o-f -p-o-t-e-n-t-i-a-l -d-o-n-o-r-s-,-'-'-;
                    -(-D-) -b-y -i-n-s-e-r-t-i-n-g -b-e-f-o-r-e -t-h-e 
                -c-o-m-m-a -i-n -s-u-b-p-a-r-a-g-r-a-p-h -(-F-) -(-a-s 
                -s-o -r-e-d-e-s-i-g-n-a-t-e-d-) -t-h-e 
                -f-o-l-l-o-w-i-n-g-: -`-`-, -w-h-i-c-h -s-y-s-t-e-m 
                -s-h-a-l-l-, -a-t -a -m-i-n-i-m-u-m-, -a-l-l-o-c-a-t-e 
                -e-a-c-h -t-y-p-e -o-f -o-r-g-a-n -e-i-t-h-e-r -o-n 
                -t-h-e -b-a-s-i-s -o-f -a -s-i-n-g-l-e -s-e-r-v-i-c-e 
                -a-r-e-a -l-i-s-t-, -o-r -a-n -a-p-p-r-o-v-e-d 
                -a-l-t-e-r-n-a-t-e -l-o-c-a-l -u-n-i-t -l-i-s-t -(-a-s 
                -d-e-f-i-n-e-d -i-n -p-a-r-a-g-r-a-p-h -(-4-)-)-, -o-f 
                -i-n-d-i-v-i-d-u-a-l-s -w-h-o -h-a-v-e -b-e-e-n 
                -m-e-d-i-c-a-l-l-y -r-e-f-e-r-r-e-d -t-o -a 
                -t-r-a-n-s-p-l-a-n-t -c-e-n-t-e-r -i-n -t-h-e 
                -s-e-r-v-i-c-e -a-r-e-a -o-f -t-h-e 
                -o-r-g-a-n-i-z-a-t-i-o-n -i-n -o-r-d-e-r -t-o 
                -r-e-c-e-i-v-e -a -t-r-a-n-s-p-l-a-n-t -o-f -t-h-e 
                -t-y-p-e -o-f -o-r-g-a-n -w-i-t-h -r-e-s-p-e-c-t -t-o 
                -w-h-i-c-h -t-h-e -l-i-s-t -i-s 
                -m-a-i-n-t-a-i-n-e-d-'-'-;
                    -(-E-) -b-y -s-t-r-i-k-i-n-g 
                -s-u-b-p-a-r-a-g-r-a-p-h -(-I-) -(-a-s -s-o 
                -r-e-d-e-s-i-g-n-a-t-e-d-) -a-n-d -i-n-s-e-r-t-i-n-g 
                -t-h-e -f-o-l-l-o-w-i-n-g -n-e-w 
                -s-u-b-p-a-r-a-g-r-a-p-h-:
            -`-`-(-I-) -b-e -a -m-e-m-b-e-r -o-f -a-n-d -a-b-i-d-e -b-y 
        -t-h-e -r-u-l-e-s -a-n-d -r-e-q-u-i-r-e-m-e-n-t-s -o-f -t-h-e 
        -O-r-g-a-n -P-r-o-c-u-r-e-m-e-n-t -a-n-d 
        -T-r-a-n-s-p-l-a-n-t-a-t-i-o-n -N-e-t-w-o-r-k 
        -e-s-t-a-b-l-i-s-h-e-d -u-n-d-e-r -s-e-c-t-i-o-n -3-7-2-,-'-'-;
                    -(-F-) -b-y -s-t-r-i-k-i-n-g 
                -s-u-b-p-a-r-a-g-r-a-p-h -(-K-) -(-a-s -s-o 
                -r-e-d-e-s-i-g-n-a-t-e-d-) -a-n-d -i-n-s-e-r-t-i-n-g 
                -t-h-e -f-o-l-l-o-w-i-n-g -n-e-w 
                -s-u-b-p-a-r-a-g-r-a-p-h-:
            -`-`-(-K-) -e-v-a-l-u-a-t-e -a-n-n-u-a-l-l-y-, -a-n-d 
        -r-e-p-o-r-t -t-o -t-h-e -O-r-g-a-n -P-r-o-c-u-r-e-m-e-n-t 
        -a-n-d -T-r-a-n-s-p-l-a-n-t-a-t-i-o-n -N-e-t-w-o-r-k 
        -e-s-t-a-b-l-i-s-h-e-d -u-n-d-e-r -s-e-c-t-i-o-n -3-7-2-, -o-n 
        -t-h-e -e-f-f-e-c-t-i-v-e-n-e-s-s -o-f -t-h-e 
        -o-r-g-a-n-i-z-a-t-i-o-n -i-n -a-c-q-u-i-r-i-n-g 
        -p-o-t-e-n-t-i-a-l-l-y -a-v-a-i-l-a-b-l-e -o-r-g-a-n-s-, 
        -p-a-r-t-i-c-u-l-a-r-l-y -a-m-o-n-g -m-i-n-o-r-i-t-y 
        -p-o-p-u-l-a-t-i-o-n-s-, -a-n-d -t-h-e -v-a-r-i-a-t-i-o-n -o-f 
        -p-r-o-c-u-r-e-m-e-n-t -a-c-r-o-s-s -h-o-s-p-i-t-a-l-s 
        -w-i-t-h-i-n -t-h-e -o-r-g-a-n -p-r-o-c-u-r-e-m-e-n-t 
        -o-r-g-a-n-i-z-a-t-i-o-n -r-e-g-i-o-n-, -a-n-d -i-d-e-n-t-i-f-y 
        -a -p-l-a-n -t-o -i-n-c-r-e-a-s-e -p-r-o-c-u-r-e-m-e-n-t-, 
        -p-a-r-t-i-c-u-l-a-r-l-y -a-m-o-n-g -m-i-n-o-r-i-t-y 
        -p-o-p-u-l-a-t-i-o-n-s -a-n-d -o-t-h-e-r -p-o-p-u-l-a-t-i-o-n-s 
        -f-o-r -w-h-i-c-h -t-h-e-r-e -i-s -a -g-r-e-a-t-e-r 
        -d-e-g-r-e-e -o-f -o-r-g-a-n -s-h-o-r-t-a-g-e-s 
        -r-e-l-a-t-i-v-e -t-o -t-h-e -g-e-n-e-r-a-l 
        -p-o-p-u-l-a-t-i-o-n-, -a-n-d -a-t -h-o-s-p-i-t-a-l-s -w-i-t-h 
        -l-o-w -r-a-t-e-s -o-f -p-r-o-c-u-r-e-m-e-n-t-,-'-'-; -a-n-d
                    -(-G-) -b-y -a-d-d-i-n-g -a-t -t-h-e -e-n-d 
                -t-h-e-r-e-o-f -t-h-e -f-o-l-l-o-w-i-n-g -f-l-u-s-h 
                -s-e-n-t-e-n-c-e-:
-`-`-S-u-b-p-a-r-a-g-r-a-p-h -(-A-) -s-h-a-l-l -n-o-t -b-e 
-c-o-n-s-t-r-u-e-d -a-s -p-r-e-c-l-u-d-i-n-g -a-n -o-r-g-a-n 
-p-r-o-c-u-r-e-m-e-n-t -o-r-g-a-n-i-z-a-t-i-o-n -f-r-o-m 
-r-e-q-u-e-s-t-i-n-g -t-h-a-t -t-h-e -S-e-c-r-e-t-a-r-y -p-e-r-m-i-t 
-c-h-a-n-g-e-s -i-n -t-h-e-i-r -s-e-r-v-i-c-e -a-r-e-a 
-b-o-u-n-d-a-r-i-e-s-.-'-'-; -a-n-d
            -(-5-) -b-y -a-d-d-i-n-g -a-t -t-h-e -e-n-d -t-h-e-r-e-o-f 
        -t-h-e -f-o-l-l-o-w-i-n-g -n-e-w -p-a-r-a-g-r-a-p-h-s-:
    -`-`-(-3-)-(-A-) -T-h-e -S-e-c-r-e-t-a-r-y -m-a-y -w-a-i-v-e -t-h-e 
-r-e-q-u-i-r-e-m-e-n-t -t-h-a-t -a-n -o-r-g-a-n -p-r-o-c-u-r-e-m-e-n-t 
-o-r-g-a-n-i-z-a-t-i-o-n -h-a-v-e -a-n -a-g-r-e-e-m-e-n-t -o-f -t-h-e 
-t-y-p-e -d-e-s-c-r-i-b-e-d -i-n -p-a-r-a-g-r-a-p-h -(-2-)-(-A-) -i-n 
-e-f-f-e-c-t -i-f---
            -`-`-(-i-)-(-I-) -t-h-e -h-o-s-p-i-t-a-l -o-r -o-t-h-e-r 
        -e-n-t-i-t-y -w-i-t-h-i-n -t-h-e -s-e-r-v-i-c-e -a-r-e-a -o-f 
        -t-h-e -o-r-g-a-n -p-r-o-c-u-r-e-m-e-n-t 
        -o-r-g-a-n-i-z-a-t-i-o-n -i-s -o-r -s-e-e-k-s -t-o -b-e -a 
        -p-a-r-t-y -t-o -s-u-c-h -a-n -a-g-r-e-e-m-e-n-t -w-i-t-h 
        -a-n-o-t-h-e-r -o-r-g-a-n -p-r-o-c-u-r-e-m-e-n-t 
        -o-r-g-a-n-i-z-a-t-i-o-n-; -a-n-d
            -`-`-(-I-I-) -t-h-e -h-o-s-p-i-t-a-l -a-n-d -o-r-g-a-n 
        -p-r-o-c-u-r-e-m-e-n-t -o-r-g-a-n-i-z-a-t-i-o-n -c-a-n 
        -d-e-m-o-n-s-t-r-a-t-e -t-o -t-h-e -s-a-t-i-s-f-a-c-t-i-o-n 
        -o-f -t-h-e -S-e-c-r-e-t-a-r-y -t-h-a-t -t-h-e-i-r 
        -a-f-f-i-l-i-a-t-i-o-n -i-s -b-a-s-e-d -o-n -a-n 
        -a-g-r-e-e-m-e-n-t -o-r -u-n-d-e-r-s-t-a-n-d-i-n-g 
        -b-e-t-w-e-e-n -t-h-e -o-r-g-a-n -p-r-o-c-u-r-e-m-e-n-t 
        -o-r-g-a-n-i-z-a-t-i-o-n -f-o-r -t-h-e -s-e-r-v-i-c-e -a-r-e-a 
        -i-n -w-h-i-c-h -t-h-e -h-o-s-p-i-t-a-l -i-s -l-o-c-a-t-e-d-, 
        -a-n-d -t-h-e -o-r-g-a-n -p-r-o-c-u-r-e-m-e-n-t 
        -o-r-g-a-n-i-z-a-t-i-o-n -w-i-t-h -w-h-i-c-h -t-h-e 
        -h-o-s-p-i-t-a-l -d-e-s-i-r-e-s -t-o -a-f-f-i-l-i-a-t-e-, 
        -a-n-d -s-u-c-h -h-o-s-p-i-t-a-l-;
            -`-`-(-i-i-) -t-h-e -h-o-s-p-i-t-a-l -o-r -o-t-h-e-r 
        -e-n-t-i-t-y -w-i-t-h-i-n -t-h-e -s-e-r-v-i-c-e -a-r-e-a -o-f 
        -t-h-e -o-r-g-a-n -p-r-o-c-u-r-e-m-e-n-t 
        -o-r-g-a-n-i-z-a-t-i-o-n -i-s -o-r -s-e-e-k-s -t-o -b-e -a 
        -p-a-r-t-y -t-o -s-u-c-h -a-n -a-g-r-e-e-m-e-n-t -w-i-t-h 
        -a-n-o-t-h-e-r -o-r-g-a-n -p-r-o-c-u-r-e-m-e-n-t 
        -o-r-g-a-n-i-z-a-t-i-o-n -a-n-d -c-a-n -d-o-c-u-m-e-n-t -t-o 
        -t-h-e -s-a-t-i-s-f-a-c-t-i-o-n -o-f -t-h-e 
        -S-e-c-r-e-t-a-r-y-, -w-i-t-h -i-n-p-u-t -f-r-o-m -t-h-e 
        -o-r-g-a-n -p-r-o-c-u-r-e-m-e-n-t -o-r-g-a-n-i-z-a-t-i-o-n 
        -f-o-r -t-h-e -a-r-e-a -i-n -w-h-i-c-h -t-h-e -h-o-s-p-i-t-a-l 
        -i-s -l-o-c-a-t-e-d-, -t-h-a-t---
                    -`-`-(-I-) -s-u-c-h -h-o-s-p-i-t-a-l -o-r 
                -e-n-t-i-t-y -h-a-s -r-e-c-e-i-v-e-d 
                -i-n-a-d-e-q-u-a-t-e -s-e-r-v-i-c-e -f-r-o-m -t-h-e 
                -o-r-g-a-n -p-r-o-c-u-r-e-m-e-n-t 
                -o-r-g-a-n-i-z-a-t-i-o-n -f-o-r -t-h-e -s-e-r-v-i-c-e 
                -a-r-e-a -i-n -w-h-i-c-h -t-h-e -h-o-s-p-i-t-a-l -i-s 
                -l-o-c-a-t-e-d-; -a-n-d
                    -`-`-(-I-I-) -a-n-o-t-h-e-r -o-r-g-a-n 
                -p-r-o-c-u-r-e-m-e-n-t -o-r-g-a-n-i-z-a-t-i-o-n -i-s 
                -w-i-l-l-i-n-g -a-n-d -a-b-l-e -t-o -p-r-o-v-i-d-e 
                -s-u-c-h -h-o-s-p-i-t-a-l -o-r -e-n-t-i-t-y 
                -a-d-e-q-u-a-t-e -s-e-r-v-i-c-e-; -o-r
            -`-`-(-i-i-i-) -i-n -s-u-c-h -o-t-h-e-r 
        -c-i-r-c-u-m-s-t-a-n-c-e-s -a-s -d-e-s-c-r-i-b-e-d -i-n 
        -r-e-g-u-l-a-t-i-o-n-s -p-r-o-m-u-l-g-a-t-e-d -b-y -t-h-e 
        -S-e-c-r-e-t-a-r-y-.
    -`-`-(-B-) -T-h-e -r-e-l-a-t-i-o-n-s-h-i-p -o-f -a -h-o-s-p-i-t-a-l 
-o-r -o-t-h-e-r -e-n-t-i-t-y -w-i-t-h-i-n -t-h-e -s-e-r-v-i-c-e 
-a-r-e-a -o-f -t-h-e -o-r-g-a-n -p-r-o-c-u-r-e-m-e-n-t 
-o-r-g-a-n-i-z-a-t-i-o-n -w-i-t-h -o-t-h-e-r -o-r-g-a-n 
-p-r-o-c-u-r-e-m-e-n-t -o-r-g-a-n-i-z-a-t-i-o-n-s -o-u-t-s-i-d-e -t-h-e 
-s-e-r-v-i-c-e -a-r-e-a -t-h-a-t -w-a-s -i-n -e-f-f-e-c-t -a-s -o-f 
-J-u-n-e -2-9-, -1-9-9-3-, -m-a-y -c-o-n-t-i-n-u-e -i-n -e-f-f-e-c-t-, 
-p-e-n-d-i-n-g -a -d-e-t-e-r-m-i-n-a-t-i-o-n -b-y -t-h-e 
-S-e-c-r-e-t-a-r-y -u-n-d-e-r -t-h-e -w-a-i-v-e-r -p-r-o-c-e-s-s 
-d-e-s-c-r-i-b-e-d -i-n -s-u-b-p-a-r-a-g-r-a-p-h -(-A-)-. -N-o-t 
-l-a-t-e-r -t-h-a-n -3 -m-o-n-t-h-s -a-f-t-e-r -t-h-e -d-a-t-e -o-f 
-e-n-a-c-t-m-e-n-t -o-f -t-h-i-s -p-a-r-a-g-r-a-p-h-, -t-h-e 
-h-o-s-p-i-t-a-l -o-r -o-t-h-e-r -e-n-t-i-t-y -s-h-a-l-l -n-o-t-i-f-y 
-t-h-e -S-e-c-r-e-t-a-r-y -i-n -w-r-i-t-i-n-g -o-f -i-t-s -i-n-t-e-n-t 
-t-o -p-r-o-c-e-e-d -w-i-t-h -s-u-c-h -a-n -e-x-i-s-t-i-n-g 
-r-e-l-a-t-i-o-n-s-h-i-p-.
    -`-`-(-C-)-(-i-) -T-h-e -O-f-f-i-c-e -o-f -T-e-c-h-n-o-l-o-g-y 
-A-s-s-e-s-s-m-e-n-t -s-h-a-l-l -c-o-n-d-u-c-t -a -s-t-u-d-y -f-o-r 
-t-h-e -p-u-r-p-o-s-e -o-f -d-e-f-i-n-i-n-g---
            -`-`-(-I-) -t-h-e -a-p-p-r-o-p-r-i-a-t-e -s-t-a-n-d-a-r-d-s 
        -b-y -w-h-i-c-h -t-o -j-u-d-g-e -t-h-e -q-u-a-l-i-t-y -o-f 
        -p-e-r-f-o-r-m-a-n-c-e -o-f -o-r-g-a-n -p-r-o-c-u-r-e-m-e-n-t 
        -o-r-g-a-n-i-z-a-t-i-o-n-s-;
            -`-`-(-I-I-) -t-h-e -p-r-o-p-e-r -c-r-i-t-e-r-i-a -f-o-r -a 
        -d-e-t-e-r-m-i-n-a-t-i-o-n -o-f -i-n-a-d-e-q-u-a-t-e 
        -s-e-r-v-i-c-e -f-r-o-m -a-n -o-r-g-a-n -p-r-o-c-u-r-e-m-e-n-t 
        -o-r-g-a-n-i-z-a-t-i-o-n-; -a-n-d
            -`-`-(-I-I-I-) -t-h-e -p-r-o-c-e-s-s -f-o-r 
        -a-l-l-o-w-i-n-g -a -h-o-s-p-i-t-a-l -t-o -w-o-r-k -w-i-t-h 
        -a-n -o-r-g-a-n -p-r-o-c-u-r-e-m-e-n-t -o-r-g-a-n-i-z-a-t-i-o-n 
        -o-u-t-s-i-d-e -i-t-s -s-e-r-v-i-c-e -a-r-e-a-.
    -`-`-(-i-i-) -N-o-t -l-a-t-e-r -t-h-a-n -1 -y-e-a-r -a-f-t-e-r 
-t-h-e -d-a-t-e -o-f -e-n-a-c-t-m-e-n-t -o-f -t-h-i-s 
-p-a-r-a-g-r-a-p-h-, -t-h-e -O-f-f-i-c-e -o-f -T-e-c-h-n-o-l-o-g-y 
-A-s-s-e-s-s-m-e-n-t -s-h-a-l-l -c-o-m-p-l-e-t-e -t-h-e -s-t-u-d-y 
-r-e-q-u-i-r-e-d -u-n-d-e-r -c-l-a-u-s-e -(-i-) -a-n-d -p-r-e-p-a-r-e 
-a-n-d -s-u-b-m-i-t -t-o -t-h-e -C-o-m-m-i-t-t-e-e -o-n -L-a-b-o-r 
-a-n-d -H-u-m-a-n -R-e-s-o-u-r-c-e-s -o-f -t-h-e -S-e-n-a-t-e-, -t-h-e 
-C-o-m-m-i-t-t-e-e -o-n -E-n-e-r-g-y -a-n-d -C-o-m-m-e-r-c-e -o-f 
-t-h-e -H-o-u-s-e -o-f -R-e-p-r-e-s-e-n-t-a-t-i-v-e-s-, -a-n-d -t-h-e 
-S-e-c-r-e-t-a-r-y-, -a -r-e-p-o-r-t -d-e-s-c-r-i-b-i-n-g -t-h-e 
-f-i-n-d-i-n-g-s -m-a-d-e -a-s -a -r-e-s-u-l-t -o-f -t-h-e -s-t-u-d-y-.
    -`-`-(-4-)-(-A-) -A-s -u-s-e-d -i-n -p-a-r-a-g-r-a-p-h 
-(-2-)-(-F-)-, -t-h-e -t-e-r-m -`-a-l-t-e-r-n-a-t-i-v-e -l-o-c-a-l 
-u-n-i-t-' -m-e-a-n-s---
            -`-`-(-i-) -a -u-n-i-t -c-o-m-p-o-s-e-d -o-f -t-w-o -o-r 
        -m-o-r-e -c-o-n-t-i-g-u-o-u-s -o-r-g-a-n -p-r-o-c-u-r-e-m-e-n-t 
        -o-r-g-a-n-i-z-a-t-i-o-n-s-; -o-r
            -`-`-(-i-i-) -a -s-u-b-d-i-v-i-s-i-o-n -o-f -a-n -o-r-g-a-n 
        -p-r-o-c-u-r-e-m-e-n-t -o-r-g-a-n-i-z-a-t-i-o-n -t-h-a-t 
        -o-p-e-r-a-t-e-s -a-s -a -d-i-s-t-i-n-c-t 
        -p-r-o-c-u-r-e-m-e-n-t -a-n-d -d-i-s-t-r-i-b-u-t-i-o-n -u-n-i-t 
        -a-s -a -r-e-s-u-l-t -o-f -s-p-e-c-i-a-l -g-e-o-g-r-a-p-h-i-c 
        -o-r -m-i-n-o-r-i-t-y -p-o-p-u-l-a-t-i-o-n -c-o-n-c-e-r-n-s 
        -b-u-t -t-h-a-t -i-s -n-o-t -c-o-m-p-o-s-e-d -o-f -a-n-y 
        -s-u-b-u-n-i-t -o-f -a -m-e-t-r-o-p-o-l-i-t-a-n 
        -s-t-a-t-i-s-t-i-c-a-l -a-r-e-a-.
    -`-`-(-B-) -T-h-e -O-r-g-a-n -P-r-o-c-u-r-e-m-e-n-t -a-n-d 
-T-r-a-n-s-p-l-a-n-t-a-t-i-o-n -N-e-t-w-o-r-k -s-h-a-l-l -m-a-k-e 
-r-e-c-o-m-m-e-n-d-a-t-i-o-n-s -t-o -t-h-e -S-e-c-r-e-t-a-r-y 
-c-o-n-c-e-r-n-i-n-g -t-h-e -a-p-p-r-o-v-a-l -o-r -d-e-n-i-a-l -o-f 
-a-l-t-e-r-n-a-t-i-v-e -l-o-c-a-l -u-n-i-t-. -T-h-e -N-e-t-w-o-r-k 
-s-h-a-l-l -a-s-s-e-s-s -w-h-e-t-h-e-r -t-h-e -a-l-t-e-r-n-a-t-i-v-e 
-l-o-c-a-l -u-n-i-t-s -w-i-l-l -b-e-t-t-e-r -p-r-o-m-o-t-e -o-r-g-a-n 
-d-o-n-a-t-i-o-n -a-n-d -t-h-e -e-q-u-i-t-a-b-l-e -a-l-l-o-c-a-t-i-o-n 
-o-f -o-r-g-a-n-s-.
    -`-`-(-C-) -T-h-e -S-e-c-r-e-t-a-r-y -s-h-a-l-l -a-p-p-r-o-v-e -o-r 
-d-e-n-y -a-n-y -a-l-t-e-r-n-a-t-i-v-e -l-o-c-a-l -u-n-i-t 
-p-r-i-n-c-i-p-l-e -o-r -d-e-s-i-g-n-a-t-i-o-n -r-e-c-o-m-m-e-n-d-e-d 
-b-y -t-h-e -N-e-t-w-o-r-k-. -I-f -t-h-e -S-e-c-r-e-t-a-r-y -d-o-e-s 
-n-o-t -p-r-o-v-i-d-e -o-t-h-e-r-w-i-s-e -p-r-i-o-r -t-o -t-h-e 
-e-x-p-i-r-a-t-i-o-n -o-f -t-h-e -9-0---d-a-y -p-e-r-i-o-d 
-b-e-g-i-n-n-i-n-g -o-n -t-h-e -d-a-t-e -o-n -w-h-i-c-h -t-h-e 
-a-p-p-l-i-c-a-t-i-o-n -i-s -s-u-b-m-i-t-t-e-d-, -t-h-e 
-r-e-c-o-m-m-e-n-d-a-t-i-o-n-s -o-f -t-h-e -N-e-t-w-o-r-k -u-n-d-e-r 
-s-u-b-p-a-r-a-g-r-a-p-h -(-B-) -w-i-t-h -r-e-s-p-e-c-t -t-o -t-h-e 
-a-p-p-l-i-c-a-t-i-o-n -o-f -t-h-e -a-l-t-e-r-n-a-t-i-v-e -l-o-c-a-l 
-u-n-i-t -s-h-a-l-l -g-o -i-n-t-o -e-f-f-e-c-t-.-'-'-.

-S-E-C-. -3-. -O-R-G-A-N -P-R-O-C-U-R-E-M-E-N-T -A-N-D 
              -T-R-A-N-S-P-L-A-N-T-A-T-I-O-N -N-E-T-W-O-R-K-.

    -S-e-c-t-i-o-n -3-7-2-(-b-) -o-f -t-h-e -P-u-b-l-i-c -H-e-a-l-t-h 
-S-e-r-v-i-c-e -A-c-t -(-4-2 -U-.-S-.-C-. -2-7-4-(-b-)-) -i-s 
-a-m-e-n-d-e-d---
            -(-1-) -i-n -p-a-r-a-g-r-a-p-h -(-1-)-(-B-)---
                    -(-A-) -i-n -c-l-a-u-s-e -(-i-)---
                            -(-i-) -b-y -s-t-r-i-k-i-n-g 
                        -`-`-(-i-n-c-l-u-d-i-n-g 
                        -o-r-g-a-n-i-z-a-t-i-o-n-s -t-h-a-t -h-a-v-e 
                        -r-e-c-e-i-v-e-d -g-r-a-n-t-s -u-n-d-e-r 
                        -s-e-c-t-i-o-n -3-7-1-)-'-'-; -a-n-d
                            -(-i-i-) -b-y -s-t-r-i-k-i-n-g 
                        -`-`-a-n-d-'-' -a-t -t-h-e -e-n-d 
                        -t-h-e-r-e-o-f -a-n-d -i-n-s-e-r-t-i-n-g 
                        -`-`-i-n-c-l-u-d-i-n-g -b-o-t-h 
                        -i-n-d-i-v-i-d-u-a-l-s -w-h-o -h-a-v-e 
                        -r-e-c-e-i-v-e-d -a -t-r-a-n-s-p-l-a-n-t -o-f 
                        -a-n -o-r-g-a-n -(-o-r -t-r-a-n-s-p-l-a-n-t 
                        -c-a-n-d-i-d-a-t-e-s-)-, -a-n-d 
                        -i-n-d-i-v-i-d-u-a-l-s -w-h-o -a-r-e -p-a-r-t 
                        -o-f -t-h-e -f-a-m-i-l-y -o-f 
                        -i-n-d-i-v-i-d-u-a-l-s -w-h-o -h-a-v-e 
                        -d-o-n-a-t-e-d -a-n -o-r-g-a-n-, -t-h-e 
                        -n-u-m-b-e-r -o-f -w-h-o-m -s-h-a-l-l -m-a-k-e 
                        -u-p -n-o-t -l-e-s-s -t-h-a-n -3-3 
                        -p-e-r-c-e-n-t -o-f -t-h-e -t-o-t-a-l 
                        -n-u-m-b-e-r -o-f -b-o-a-r-d 
                        -m-e-m-b-e-r-s-'-'-; -a-n-d
                    -(-B-) -i-n -c-l-a-u-s-e -(-i-i-)-, -b-y 
                -i-n-s-e-r-t-i-n-g -`-`-i-n-c-l-u-d-i-n-g -a 
                -p-a-t-i-e-n-t -a-f-f-a-i-r-s -c-o-m-m-i-t-t-e-e-'-' 
                -a-f-t-e-r -`-`-c-o-m-m-i-t-t-e-e-s-,-'-'-;
            -(-2-) -i-n -p-a-r-a-g-r-a-p-h -(-2-)---
                    -(-A-) -b-y -s-t-r-i-k-i-n-g -c-l-a-u-s-e 
                -(-A-)-(-i-) -a-n-d -i-n-s-e-r-t-i-n-g -t-h-e 
                -f-o-l-l-o-w-i-n-g -n-e-w -c-l-a-u-s-e-:
                    -`-`-(-i-) -w-i-t-h -r-e-s-p-e-c-t -t-o -e-a-c-h 
                -t-y-p-e -o-f -t-r-a-n-s-p-l-a-n-t-, -a 
                -n-a-t-i-o-n-a-l -l-i-s-t -o-f -i-n-d-i-v-i-d-u-a-l-s 
                -w-h-o -h-a-v-e -b-e-e-n -m-e-d-i-c-a-l-l-y 
                -r-e-f-e-r-r-e-d -t-o -r-e-c-e-i-v-e -a 
                -t-r-a-n-s-p-l-a-n-t -o-f -t-h-e -t-y-p-e -o-f 
                -o-r-g-a-n-s -w-i-t-h -r-e-s-p-e-c-t -t-o -w-h-i-c-h 
                -t-h-e -l-i-s-t -i-s -m-a-i-n-t-a-i-n-e-d -(-w-h-i-c-h 
                -l-i-s-t -s-h-a-l-l -i-n-c-l-u-d-e -t-h-e -n-a-m-e-s 
                -o-f -a-l-l -i-n-d-i-v-i-d-u-a-l-s -i-n-c-l-u-d-e-d 
                -o-n -l-i-s-t-s -i-n -e-f-f-e-c-t -u-n-d-e-r 
                -s-e-c-t-i-o-n -3-7-1-(-b-)-(-2-)-(-F-)-, -a-n-d-'-'-;
                    -(-B-) -i-n -s-u-b-p-a-r-a-g-r-a-p-h -(-B-)-, -b-y 
                -i-n-s-e-r-t-i-n-g -`-`-, -i-n-c-l-u-d-i-n-g 
                -r-e-q-u-i-r-e-m-e-n-t-s -u-n-d-e-r -s-e-c-t-i-o-n 
                -3-7-1-(-b-)-,-'-' -a-f-t-e-r -`-`-m-e-m-b-e-r-s-h-i-p 
                -c-r-i-t-e-r-i-a-'-'-;
                    -(-C-) -i-n -s-u-b-p-a-r-a-g-r-a-p-h -(-D-)-, -t-o 
                -r-e-a-d -a-s -f-o-l-l-o-w-s-:
            -`-`-(-D-) -d-e-v-e-l-o-p -a-n-d -r-e-p-o-r-t -t-o -t-h-e 
        -S-e-c-r-e-t-a-r-y-, -n-o-t -l-a-t-e-r -t-h-a-n 
        -S-e-p-t-e-m-b-e-r -3-0-, -1-9-9-4-, -a-n-d -i-m-p-l-e-m-e-n-t 
        -n-o-t -l-a-t-e-r -t-h-a-n -S-e-p-t-e-m-b-e-r -3-0-, -1-9-9-5-, 
        -a -s-y-s-t-e-m -o-f -a-l-l-o-c-a-t-i-n-g -o-r-g-a-n-s -i-n 
        -o-r-d-e-r -t-o -e-n-s-u-r-e -t-h-a-t -p-a-t-i-e-n-t-s -i-n 
        -o-n-e -r-e-g-i-o-n -h-a-v-e -a-n -e-q-u-i-v-a-l-e-n-t 
        -p-r-o-b-a-b-i-l-i-t-y -o-f -r-e-c-e-i-v-i-n-g -a-n -o-r-g-a-n 
        -a-s -d-o -p-a-t-i-e-n-t-s -w-i-t-h -s-i-m-i-l-a-r 
        -c-h-a-r-a-c-t-e-r-i-s-t-i-c-s -i-n -a-n-o-t-h-e-r 
        -r-e-g-i-o-n-,-'-'-;
                    -(-D-) -b-y -r-e-d-e-s-i-g-n-a-t-i-n-g 
                -s-u-b-p-a-r-a-g-r-a-p-h-s -(-E-) -t-h-r-o-u-g-h 
                -(-L-)-, -a-s -s-u-b-p-a-r-a-g-r-a-p-h-s -(-F-) 
                -t-h-r-o-u-g-h -(-M-)-, -r-e-s-p-e-c-t-i-v-e-l-y-;
                    -(-E-) -b-y -i-n-s-e-r-t-i-n-g -a-f-t-e-r 
                -s-u-b-p-a-r-a-g-r-a-p-h -(-D-)-, -t-h-e 
                -f-o-l-l-o-w-i-n-g -n-e-w -s-u-b-p-a-r-a-g-r-a-p-h-:
            -`-`-(-E-) -a-s-s-i-s-t -o-r-g-a-n -p-r-o-c-u-r-e-m-e-n-t 
        -o-r-g-a-n-i-z-a-t-i-o-n-s -i-n -t-h-e -e-q-u-i-t-a-b-l-e 
        -d-i-s-t-r-i-b-u-t-i-o-n -o-f -o-r-g-a-n-s -a-m-o-n-g 
        -t-r-a-n-s-p-l-a-n-t -p-a-t-i-e-n-t-s-,-'-'-;
                    -(-F-) -i-n -s-u-b-p-a-r-a-g-r-a-p-h -(-K-) -(-a-s 
                -s-o -r-e-d-e-s-i-g-n-a-t-e-d-)-, -b-y -s-t-r-i-k-i-n-g 
                -`-`-a-n-d-'-' -a-t -t-h-e -e-n-d -t-h-e-r-e-o-f-;
                    -(-G-) -i-n -s-u-b-p-a-r-a-g-r-a-p-h -(-L-) -(-a-s 
                -s-o -r-e-d-e-s-i-g-n-a-t-e-d-)-, -b-y -s-t-r-i-k-i-n-g 
                -t-h-e -p-e-r-i-o-d -a-n-d -i-n-s-e-r-t-i-n-g -`-`-, 
                -i-n-c-l-u-d-i-n-g -m-a-k-i-n-g 
                -r-e-c-o-m-m-e-n-d-a-t-i-o-n-s -t-o -o-r-g-a-n 
                -p-r-o-c-u-r-e-m-e-n-t-s -o-r-g-a-n-i-z-a-t-i-o-n-s 
                -a-n-d -t-h-e -S-e-c-r-e-t-a-r-y -b-a-s-e-d -o-n -t-h-e 
                -a-n-n-u-a-l -r-e-p-o-r-t-s -r-e-q-u-i-r-e-d -u-n-d-e-r 
                -s-e-c-t-i-o-n -3-7-1-(-b-)-(-2-)-(-K-)-,-'-'-;
                    -(-H-) -i-n -s-u-b-p-a-r-a-g-r-a-p-h -(-M-) -(-a-s 
                -s-o -r-e-d-e-s-i-g-n-a-t-e-d-)-, -b-y -s-t-r-i-k-i-n-g 
                -t-h-e -p-e-r-i-o-d -a-n-d -i-n-s-e-r-t-i-n-g -a 
                -c-o-m-m-a-; -a-n-d
                    -(-I-) -b-y -a-d-d-i-n-g -a-t -t-h-e -e-n-d 
                -t-h-e-r-e-o-f -t-h-e -f-o-l-l-o-w-i-n-g -n-e-w 
                -s-u-b-p-a-r-a-g-r-a-p-h-s-:
            -`-`-(-N-) -s-u-b-m-i-t -t-o -t-h-e -S-e-c-r-e-t-a-r-y 
        -f-o-r -r-e-v-i-e-w -a-n-d -a-p-p-r-o-v-a-l -a-n-y -c-h-a-n-g-e 
        -i-n -t-h-e -a-m-o-u-n-t -o-f -f-e-e-s -i-m-p-o-s-e-d -b-y 
        -t-h-e -N-e-t-w-o-r-k -f-o-r -t-h-e -r-e-g-i-s-t-r-a-t-i-o-n 
        -o-f -i-n-d-i-v-i-d-u-a-l-s -o-n -t-h-e -l-i-s-t-s 
        -m-a-i-n-t-a-i-n-e-d -u-n-d-e-r -s-u-b-p-a-r-a-g-r-a-p-h 
        -(-A-)-(-i-)-, -s-u-c-h -c-h-a-n-g-e -t-o -b-e 
        -c-o-n-s-i-d-e-r-e-d -a-s -a-p-p-r-o-v-e-d -i-f -t-h-e 
        -S-e-c-r-e-t-a-r-y -d-o-e-s -n-o-t -p-r-o-v-i-d-e 
        -o-t-h-e-r-w-i-s-e -p-r-i-o-r -t-o -t-h-e -e-x-p-i-r-a-t-i-o-n 
        -o-f -t-h-e -9-0---d-a-y -p-e-r-i-o-d -b-e-g-i-n-n-i-n-g -o-n 
        -t-h-e -d-a-t-e -o-n -w-h-i-c-h -t-h-e -c-h-a-n-g-e -i-s 
        -s-u-b-m-i-t-t-e-d -t-o -t-h-e -S-e-c-r-e-t-a-r-y-,
            -`-`-(-O-) -m-a-k-e -a-v-a-i-l-a-b-l-e -t-o -t-h-e 
        -S-e-c-r-e-t-a-r-y -s-u-c-h -i-n-f-o-r-m-a-t-i-o-n-, 
        -b-o-o-k-s-, -a-n-d -r-e-c-o-r-d-s -r-e-g-a-r-d-i-n-g -t-h-e 
        -N-e-t-w-o-r-k -a-s -t-h-e -S-e-c-r-e-t-a-r-y -m-a-y 
        -r-e-q-u-i-r-e-,
            -`-`-(-P-) -s-u-b-m-i-t -t-o -t-h-e -S-e-c-r-e-t-a-r-y-, 
        -o-n -a-n -a-n-n-u-a-l -b-a-s-i-s-, -a -r-e-p-o-r-t -o-n -t-h-e 
        -c-l-i-n-i-c-a-l -a-n-d -s-c-i-e-n-t-i-f-i-c -s-t-a-t-u-s -o-f 
        -t-h-e -o-r-g-a-n -t-r-a-n-s-p-l-a-n-t-a-t-i-o-n-s-, -a-n-d
            -`-`-(-Q-) -m-e-e-t -s-u-c-h -o-t-h-e-r -c-r-i-t-e-r-i-a 
        -r-e-g-a-r-d-i-n-g -c-o-m-p-l-i-a-n-c-e -w-i-t-h -t-h-i-s 
        -p-a-r-t -a-s -t-h-e -S-e-c-r-e-t-a-r-y -m-a-y 
        -e-s-t-a-b-l-i-s-h-.-'-'-; -a-n-d
            -(-3-) -b-y -a-d-d-i-n-g -a-t -t-h-e -e-n-d -t-h-e-r-e-o-f 
        -t-h-e -f-o-l-l-o-w-i-n-g -n-e-w -p-a-r-a-g-r-a-p-h-:
    -`-`-(-3-) -I-n -c-a-r-r-y-i-n-g -o-u-t -p-a-r-a-g-r-a-p-h 
-(-2-)-(-D-)-, -t-h-e -O-r-g-a-n -P-r-o-c-u-r-e-m-e-n-t -a-n-d 
-T-r-a-n-s-p-l-a-n-t-a-t-i-o-n -N-e-t-w-o-r-k -s-h-a-l-l -c-o-n-s-u-l-t 
-w-i-t-h -e-x-p-e-r-t-s -i-n -t-h-e -a-r-e-a -o-f -o-r-g-a-n 
-a-l-l-o-c-a-t-i-o-n -a-n-d -o-r-g-a-n -d-o-n-a-t-i-o-n-s -a-n-d 
-c-o-n-s-i-d-e-r -t-h-e-i-r -r-e-c-o-m-m-e-n-d-a-t-i-o-n-s 
-r-e-g-a-r-d-i-n-g -t-h-e -e-s-t-a-b-l-i-s-h-m-e-n-t -o-f 
-r-e-g-i-o-n-s -i-n -t-h-e -c-o-u-n-t-r-y -f-o-r -t-h-e -p-u-r-p-o-s-e 
-o-f -a-l-l-o-c-a-t-i-n-g -o-r-g-a-n-s-.-'-'-.

-S-E-C-. -4-. -S-T-U-D-Y -B-Y -G-E-N-E-R-A-L -A-C-C-O-U-N-T-I-N-G 
              -O-F-F-I-C-E-.

    -S-e-c-t-i-o-n -3-7-7 -o-f -t-h-e -P-u-b-l-i-c -H-e-a-l-t-h 
-S-e-r-v-i-c-e -A-c-t -(-4-2 -U-.-S-.-C-. -2-7-4-f-) -i-s 
-a-m-e-n-d-e-d -t-o -r-e-a-d -a-s -f-o-l-l-o-w-s-:

-`-`-S-E-C-. -3-7-7-. -S-T-U-D-Y -B-Y -G-E-N-E-R-A-L 
              -A-C-C-O-U-N-T-I-N-G -O-F-F-I-C-E-.

    -`-`-(-a-) -I-n -G-e-n-e-r-a-l-.----T-h-e -C-o-m-p-t-r-o-l-l-e-r 
-G-e-n-e-r-a-l -o-f -t-h-e -U-n-i-t-e-d -S-t-a-t-e-s -s-h-a-l-l 
-c-o-n-d-u-c-t -a -s-t-u-d-y -f-o-r -t-h-e -p-u-r-p-o-s-e -o-f 
-d-e-t-e-r-m-i-n-i-n-g -a-n-d -m-a-k-i-n-g 
-r-e-c-o-m-m-e-n-d-a-t-i-o-n-s -c-o-n-c-e-r-n-i-n-g---
            -`-`-(-1-) -t-h-e -c-o-m-p-o-s-i-t-i-o-n -o-f -t-h-e 
        -b-o-a-r-d-s -o-f -d-i-r-e-c-t-o-r-s -o-f -o-r-g-a-n 
        -p-r-o-c-u-r-e-m-e-n-t -o-r-g-a-n-i-z-a-t-i-o-n-s -a-n-d -o-f 
        -t-h-e -O-r-g-a-n -P-r-o-c-u-r-e-m-e-n-t -a-n-d 
        -T-r-a-n-s-p-l-a-n-t-a-t-i-o-n -N-e-t-w-o-r-k -o-n -t-h-e 
        -d-a-t-e -o-f -e-n-a-c-t-m-e-n-t -o-f -t-h-i-s -s-e-c-t-i-o-n-, 
        -a-n-d -t-h-e -e-f-f-e-c-t -o-f -t-h-e -O-r-g-a-n 
        -T-r-a-n-s-p-l-a-n-t -P-r-o-g-r-a-m 
        -R-e-a-u-t-h-o-r-i-z-a-t-i-o-n -A-c-t -o-f -1-9-9-3 -o-n -t-h-e 
        -c-o-m-p-o-s-i-t-i-o-n -a-n-d -f-u-n-c-t-i-o-n-i-n-g -o-f 
        -s-u-c-h -b-o-a-r-d-s-;
            -`-`-(-2-)-(-A-) -t-h-e -n-u-m-b-e-r -a-n-d 
        -p-e-r-c-e-n-t-a-g-e -o-f -c-a-d-a-v-e-r-i-c -o-r-g-a-n 
        -t-r-a-n-s-p-l-a-n-t-s -f-o-r -f-o-r-e-i-g-n -n-a-t-i-o-n-a-l-s 
        -c-a-t-e-g-o-r-i-z-e-d -b-y -o-r-g-a-n -p-r-o-c-u-r-e-m-e-n-t 
        -o-r-g-a-n-i-z-a-t-i-o-n -a-n-d -b-y -t-r-a-n-s-p-l-a-n-t 
        -c-e-n-t-e-r-;
            -`-`-(-B-) -t-h-e -n-u-m-b-e-r -a-n-d -p-e-r-c-e-n-t -o-f 
        -t-h-e -o-r-g-a-n-i-z-a-t-i-o-n-s -r-e-f-e-r-r-e-d -t-o -i-n 
        -s-u-b-p-a-r-a-g-r-a-p-h -(-A-) -a-b-o-v-e -t-h-e -o-r-g-a-n 
        -p-r-o-c-u-r-e-m-e-n-t -t-r-a-n-s-p-l-a-n-t -n-e-t-w-o-r-k 
        -g-u-i-d-e-l-i-n-e -o-f -1-0 -p-e-r-c-e-n-t-; -a-n-d
            -`-`-(-C-) -a-n-y -i-n-f-o-r-m-a-t-i-o-n -o-n -t-h-e 
        -c-u-r-r-e-n-t -r-a-t-e -o-f -o-r-g-a-n -d-o-n-a-t-i-o-n -b-y 
        -i-n-d-i-v-i-d-u-a-l-s -o-t-h-e-r -t-h-a-n -U-n-i-t-e-d 
        -S-t-a-t-e-s -c-i-t-i-z-e-n-s -o-r -l-e-g-a-l 
        -r-e-s-i-d-e-n-t-s-;
            -`-`-(-3-) -t-h-e -e-q-u-i-t-a-b-l-e -a-l-l-o-c-a-t-i-o-n 
        -o-f -o-r-g-a-n-s -n-a-t-i-o-n-w-i-d-e-, -i-n-c-l-u-d-i-n-g 
        -a-n -a-n-a-l-y-s-i-s -o-f -t-h-e -r-e-l-a-t-i-v-e 
        -p-r-o-b-a-b-i-l-i-t-y -o-f -r-e-c-e-i-v-i-n-g -a-n -o-r-g-a-n 
        -f-o-r -p-a-t-i-e-n-t-s -w-i-t-h -s-i-m-i-l-a-r 
        -c-h-a-r-a-c-t-e-r-i-s-t-i-c-s -f-o-r -e-a-c-h -c-a-t-e-g-o-r-y 
        -o-f -t-r-a-n-s-p-l-a-n-t-e-d -o-r-g-a-n -b-y -o-r-g-a-n 
        -p-r-o-c-u-r-e-m-e-n-t -o-r-g-a-n-i-z-a-t-i-o-n -a-n-d -t-h-e 
        -e-f-f-e-c-t -o-f -t-h-e -O-r-g-a-n -T-r-a-n-s-p-l-a-n-t 
        -P-r-o-g-r-a-m -R-e-a-u-t-h-o-r-i-z-a-t-i-o-n -A-c-t -o-f 
        -1-9-9-3 -o-n -i-m-p-r-o-v-i-n-g -t-h-e -e-q-u-i-t-a-b-l-e 
        -a-l-l-o-c-a-t-i-o-n -o-f -o-r-g-a-n-s -n-a-t-i-o-n-w-i-d-e-.
    -`-`-(-b-) -R-e-p-o-r-t-.----N-o-t -l-a-t-e-r -t-h-a-n -2 
-y-e-a-r-s -a-f-t-e-r -t-h-e -d-a-t-e -o-f -e-n-a-c-t-m-e-n-t -o-f 
-t-h-e -O-r-g-a-n -T-r-a-n-s-p-l-a-n-t -P-r-o-g-r-a-m 
-R-e-a-u-t-h-o-r-i-z-a-t-i-o-n -A-c-t -o-f -1-9-9-3-, -t-h-e 
-C-o-m-p-t-r-o-l-l-e-r -G-e-n-e-r-a-l -o-f -t-h-e -U-n-i-t-e-d 
-S-t-a-t-e-s -s-h-a-l-l -c-o-m-p-l-e-t-e -t-h-e -s-t-u-d-y 
-r-e-q-u-i-r-e-d -u-n-d-e-r -s-u-b-s-e-c-t-i-o-n -(-a-) -a-n-d 
-p-r-e-p-a-r-e -a-n-d -s-u-b-m-i-t -t-o -t-h-e -C-o-m-m-i-t-t-e-e -o-n 
-E-n-e-r-g-y -a-n-d -C-o-m-m-e-r-c-e -o-f -t-h-e -H-o-u-s-e -o-f 
-R-e-p-r-e-s-e-n-t-a-t-i-v-e-s-, -a-n-d -t-o -t-h-e -C-o-m-m-i-t-t-e-e 
-o-n -L-a-b-o-r -a-n-d -H-u-m-a-n -R-e-s-o-u-r-c-e-s -o-f -t-h-e 
-S-e-n-a-t-e-, -a -r-e-p-o-r-t -d-e-s-c-r-i-b-i-n-g -t-h-e 
-f-i-n-d-i-n-g-s -m-a-d-e -a-s -a -r-e-s-u-l-t -o-f -t-h-e 
-s-t-u-d-y-.-'-'-.

-S-E-C-. -5-. -G-E-N-E-R-A-L -P-R-O-V-I-S-I-O-N-S-.

    -(-a-) -L-i-m-i-t-a-t-i-o-n-.----S-e-c-t-i-o-n -3-7-4-(-b-) -o-f 
-t-h-e -P-u-b-l-i-c -H-e-a-l-t-h -S-e-r-v-i-c-e -A-c-t -(-4-2 
-U-.-S-.-C-. -2-7-4-b-(-b-)-) -i-s -a-m-e-n-d-e-d---
            -(-1-) -b-y -s-t-r-i-k-i-n-g -p-a-r-a-g-r-a-p-h -(-2-)-;
            -(-2-) -b-y -r-e-d-e-s-i-g-n-a-t-i-n-g -p-a-r-a-g-r-a-p-h 
        -(-3-) -a-s -p-a-r-a-g-r-a-p-h -(-2-)-; -a-n-d
            -(-3-) -i-n -p-a-r-a-g-r-a-p-h -(-2-) -(-a-s -s-o 
        -r-e-d-e-s-i-g-n-a-t-e-d-)-, -b-y -s-t-r-i-k-i-n-g 
        -`-`-3-7-1-(-a-)-(-3-)-'-' -a-n-d -i-n-s-e-r-t-i-n-g 
        -`-`-3-7-1-(-a-)-(-2-)-'-'-.
    -(-b-) -R-e-p-e-a-l-.----S-e-c-t-i-o-n -3-7-6 -o-f -t-h-e 
-P-u-b-l-i-c -H-e-a-l-t-h -S-e-r-v-i-c-e -A-c-t -(-4-2 -U-.-S-.-C-. 
-2-7-4-d-) -i-s -r-e-p-e-a-l-e-d-.
    -(-c-) -T-r-a-n-s-f-e-r-.----S-e-c-t-i-o-n -3-7-8 -o-f -t-h-e 
-P-u-b-l-i-c -H-e-a-l-t-h -S-e-r-v-i-c-e -A-c-t -(-4-2 -U-.-S-.-C-. 
-2-7-4-g-) -i-s -a-m-e-n-d-e-d---
            -(-1-) -b-y -t-r-a-n-s-f-e-r-r-i-n-g -s-u-c-h 
        -s-e-c-t-i-o-n -t-o -p-a-r-t -H -o-f -t-i-t-l-e -I-I-I-; -a-n-d
            -(-2-) -b-y -i-n-s-e-r-t-i-n-g -s-u-c-h -s-e-c-t-i-o-n 
        -a-f-t-e-r -s-e-c-t-i-o-n -3-7-7-.
    -(-d-) -A-u-t-h-o-r-i-z-a-t-i-o-n -o-f 
-A-p-p-r-o-p-r-i-a-t-i-o-n-s-.----S-e-c-t-i-o-n -3-7-8 -o-f -t-h-e 
-P-u-b-l-i-c -H-e-a-l-t-h -S-e-r-v-i-c-e -A-c-t -(-4-2 -U-.-S-.-C-. 
-2-7-4-g-) -i-s -a-m-e-n-d-e-d -b-y -s-t-r-i-k-i-n-g -`-`-1-9-9-1-'-' 
-a-n-d -a-l-l -t-h-a-t -f-o-l-l-o-w-s -t-h-r-o-u-g-h -t-h-e 
-p-e-r-i-o-d -a-n-d -i-n-s-e-r-t-i-n-g -`-`-1-9-9-4-, -a-n-d -s-u-c-h 
-s-u-m-s -a-s -m-a-y -b-e -n-e-c-e-s-s-a-r-y -f-o-r -e-a-c-h -o-f 
-t-h-e -f-i-s-c-a-l -y-e-a-r-s -1-9-9-5 -a-n-d -1-9-9-6-.-'-'-.

-S-E-C-. -6-. -E-F-F-E-C-T-I-V-E -D-A-T-E-S-.

    -(-a-) -I-n -G-e-n-e-r-a-l-.----E-x-c-e-p-t -a-s -p-r-o-v-i-d-e-d 
-i-n -s-u-b-s-e-c-t-i-o-n -(-b-)-, -t-h-e -a-m-e-n-d-m-e-n-t-s -m-a-d-e 
-b-y -t-h-i-s -A-c-t -s-h-a-l-l -b-e-c-o-m-e -e-f-f-e-c-t-i-v-e -o-n 
-t-h-e -d-a-t-e -o-f -e-n-a-c-t-m-e-n-t -o-f -t-h-i-s -A-c-t-.
    -(-b-) -E-x-c-e-p-t-i-o-n-.----T-h-e -a-m-e-n-d-m-e-n-t-s -m-a-d-e 
-b-y -s-e-c-t-i-o-n-s -2-(-b-)-(-4-)-(-A-) -a-n-d -2-(-b-)-(-4-)-(-D-) 
-s-h-a-l-l -b-e-c-o-m-e -e-f-f-e-c-t-i-v-e -6 -m-o-n-t-h-s -a-f-t-e-r 
-t-h-e -d-a-t-e -o-f -e-n-a-c-t-m-e-n-t -o-f -t-h-i-s -A-c-t-. 
-P-r-i-o-r -t-o -s-u-c-h -d-a-t-e-, -s-e-c-t-i-o-n-s 
-3-7-1-(-b-)-(-3-)-(-A-) -a-n-d -3-7-1-(-b-)-(-3-)-(-E-) -o-f -t-h-e 
-P-u-b-l-i-c -H-e-a-l-t-h -S-e-r-v-i-c-e -A-c-t-, -a-s -i-n 
-e-f-f-e-c-t -o-n -t-h-e -d-a-y -b-e-f-o-r-e -t-h-e -d-a-t-e -o-f 
-t-h-e -e-n-a-c-t-m-e-n-t -o-f -t-h-i-s -A-c-t-, -s-h-a-l-l 
-r-e-m-a-i-n -i-n -e-f-f-e-c-t-.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Organ Transplant Program 
Reauthorization Act of 1993''.

SEC. 2. ORGAN PROCUREMENT ORGANIZATIONS.

    (a) In General.--Subsection (a) of section 371 of the Public Health 
Service Act (42 U.S.C. 273(a)) is amended to read as follows:
    ``(a)(1) The Secretary may make grants for the consolidation and 
expansion of qualified organ procurement organizations described in 
subsection (b).
    ``(2) The Secretary may make grants to, and enter into cooperative 
agreements and contracts with, qualified organ procurement 
organizations described in subsection (b) and other public or nonprofit 
private entities for the purpose of increasing organ donation through--
            ``(A) the planning and conducting of programs to provide 
        information and education to the public on the need for organ 
        donations;
            ``(B) the training of individuals in requesting such 
        donations; or
            ``(C) the provision of technical assistance to organ 
        procurement organizations and other entities in the health care 
        system.
    ``(3)(A) In making awards of grants, cooperative agreements and 
contracts under subparagraphs (A) and (B) of paragraph (2), the 
Secretary shall give priority to carrying out the purpose described in 
such paragraph with respect to minority or other populations for which 
there is a greater degree of organ shortages relative to the general 
population.
    ``(B) In making awards of grants, cooperative agreements and 
contracts under paragraph (2)(C), the Secretary shall give priority to 
carrying out the purpose described in such paragraph with respect to 
organ procurement organizations and hospitals with lower rates of 
procurement relative to other such organizations or hospitals.''.
    (b) Qualified Organ Procurement Organizations.--Section 371(b) of 
such Act (42 U.S.C. 273(b)) is amended--
            (1) in paragraph (1)--
                    (A) in the matter preceding subparagraph (A), by 
                striking ``for which grants may be made under 
                subsection (a)'' and inserting ``described in this 
                section'';
                    (B) by realigning the margin of subparagraph (E) so 
                as to align with the margin of subparagraph (D); and
                    (C) in subparagraph (G)--
                            (i) in the matter preceding clause (i), by 
                        striking ``directors or an advisory board'' and 
                        inserting ``directors (or an advisory board, in 
                        the case of a hospital-based organ procurement 
                        organization established prior to September 1, 
                        1993)''; and
                            (ii) in clause (i)--
                                    (I) by striking ``composed of'' in 
                                the matter preceding subclause (I) and 
                                inserting ``composed of a reasonable 
                                balance of''; and
                                    (II) by inserting before the comma 
                                in subclause (II) the following: ``, 
                                including individuals who have received 
                                a transplant of an organ (or transplant 
                                candidates), and individuals who are 
                                part of the family of an individual who 
                                has donated an organ'';
            (2) by striking paragraph (2);
            (3) by redesignating paragraph (3) as paragraph (2);
            (4) in paragraph (2) (as so redesignated)--
                    (A) by redesignating subparagraphs (B) through (K) 
                as subparagraphs (C) through (L), respectively,
                    (B) by inserting after subparagraph (A) the 
                following new subparagraph:
            ``(B) conduct and participate in systematic efforts, 
        including public education, to increase the number of potential 
        donors,'';
                    (C) by inserting before the comma in subparagraph 
                (F) (as so redesignated) the following: ``, which 
                system shall, at a minimum, allocate each type of organ 
                on the basis of--
                    ``(i) a single list encompassing the entire service 
                area;
                    ``(ii) a list that encompasses at least an entire 
                State; or
                    ``(iii) a list that encompasses an approved 
                alternative local unit (as defined in paragraph (4)),
        of individuals who have been medically referred to a transplant 
        center in the service area of the organization in order to 
        receive a transplant of the type of organ with respect to which 
        the list is maintained;'';
                    (D) by striking subparagraph (I) (as so 
                redesignated) and inserting the following new 
                subparagraph:
            ``(I) be a member of and abide by the rules and 
        requirements of the Organ Procurement and Transplantation 
        Network established under section 372,''; and
                    (E) by striking subparagraph (K) (as so 
                redesignated) and inserting the following new 
                subparagraph:
            ``(K) evaluate annually, and report to the Organ 
        Procurement and Transplantation Network established under 
        section 372, on the effectiveness of the organization in 
        acquiring potentially available organs, particularly among 
        minority populations, and the variation of procurement across 
        hospitals within the organ procurement organization region, and 
        identify a plan to increase procurement, particularly among 
        minority populations and other populations for which there is a 
        greater degree of organ shortages relative to the general 
        population, and at hospitals with low rates of procurement, 
        and''; and
            (5) by adding at the end thereof the following new 
        paragraphs:
    ``(3)(A) The Office of Technology Assessment shall conduct a study 
for the purpose of defining--
            ``(i) the appropriate standards by which to judge the 
        quality of performance of organ procurement organizations; and
            ``(ii) the proper criteria for a determination of 
        inadequate service from an organ procurement organization.
    ``(B) Not later than 2 years after the date of enactment of this 
paragraph, the Office of Technology Assessment shall complete the study 
required under subparagraph (A) and prepare and submit to the Committee 
on Labor and Human Resources of the Senate, the Committee on Energy and 
Commerce of the House of Representatives, and the Secretary, a report 
describing the findings made as a result of the study.
    ``(C) For purposes of this paragraph the term `organ' means a human 
kidney, liver, heart, lung, pancreas, and any other human organ or 
tissue specified by the Secretary for purposes of this paragraph.
    ``(4)(A) As used in paragraph (2)(F), the term `alternative local 
unit' means--
            ``(i) a unit composed of two or more contiguous organ 
        procurement organizations; or
            ``(ii) a subdivision of an organ procurement organization 
        that operates as a distinct procurement and distribution unit 
        as a result of special geographic, rural, or minority 
        population concerns but that is not composed of any subunit of 
        a metropolitan statistical area.
    ``(B) The Organ Procurement and Transplantation Network shall make 
recommendations to the Secretary concerning the approval or denial of 
alternative local units. The Network shall assess whether the 
alternative local units will better promote organ donation and the 
equitable allocation of organs.
    ``(C) The Secretary shall approve or deny any alternative local 
unit principle or designation recommended by the Network. If the 
Secretary does not provide otherwise prior to the expiration of the 90-
day period beginning on the date on which the application is submitted, 
the recommendations of the Network under subparagraph (B) with respect 
to the application of the alternative local unit shall go into 
effect.''.
    (c) Effective Date.--The amendments made by subsection (b)(5) shall 
apply to organ procurement organizations beginning January 1, 1995.

SEC. 3. ORGAN PROCUREMENT AND TRANSPLANTATION NETWORK.

    Section 372(b) of the Public Health Service Act (42 U.S.C. 274(b)) 
is amended--
            (1) in paragraph (1)(B)--
                    (A) in clause (i)--
                            (i) by striking ``(including organizations 
                        that have received grants under section 371)''; 
                        and
                            (ii) by striking ``; and'' at the end 
                        thereof and inserting ``(including both 
                        individuals who have received a transplant of 
                        an organ (or transplant candidates), and 
                        individuals who are part of the family of 
                        individuals who have donated an organ, the 
                        number of whom shall make up not less than 40 
                        percent of the total number of board members); 
                        and''; and
                    (B) in clause (ii), by inserting ``including a 
                patient affairs committee'' after ``committees,''; and
            (2) in paragraph (2)--
                    (A) in subparagraph (A), by striking clause (i) and 
                inserting the following new clause:
                    ``(i) with respect to each type of transplant, a 
                national list of individuals who have been medically 
                referred to receive a transplant of the type of organs 
                with respect to which the list is maintained (which 
                list shall include the names of all individuals 
                included on lists in effect under section 371(b)(2)(F), 
                and'';
                    (B) in subparagraph (B), by inserting ``, including 
                requirements under section 371(b),'' after ``membership 
                criteria'';
                    (C) by redesignating subparagraphs (E) through (L), 
                as subparagraphs (F) through (M), respectively;
                    (D) by inserting after subparagraph (D), the 
                following new subparagraph:
            ``(E) assist organ procurement organizations in the 
        equitable distribution of organs among transplant patients,'';
                    (E) in subparagraph (K) (as so redesignated), by 
                striking ``and'' at the end thereof;
                    (F) in subparagraph (L) (as so redesignated), by 
                striking the period and inserting ``, including making 
                recommendations to organ procurements organizations and 
                the Secretary based on the annual reports required 
                under section 371(b)(2)(K),'';
                    (G) in subparagraph (M) (as so redesignated), by 
                striking the period and inserting a comma; and
                    (H) by adding at the end thereof the following new 
                subparagraphs:
            ``(N) submit to the Secretary for review and approval any 
        change in the amount of fees imposed by the Network for the 
        registration of individuals on the lists maintained under 
        subparagraph (A)(i), such change to be considered as approved 
        if the Secretary does not provide otherwise prior to the 
        expiration of the 90-day period beginning on the date on which 
        the change is submitted to the Secretary,
            ``(O) make available to the Secretary such information, 
        books, and records regarding the Network as the Secretary may 
        require,
            ``(P) submit to the Secretary, on an annual basis, a report 
        on the clinical and scientific status of the organ 
        transplantations, and
            ``(Q) meet such other criteria regarding compliance with 
        this part as the Secretary may establish.''.

SEC. 4. STUDY BY GENERAL ACCOUNTING OFFICE.

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

``SEC. 377. STUDY BY GENERAL ACCOUNTING OFFICE.

    ``(a) Study.--
            ``(1) In general.--The Comptroller General of the United 
        States shall conduct a study for the purpose of determining and 
        making recommendations concerning--
                    ``(A) the composition of the boards of directors of 
                organ procurement organizations and of the Organ 
                Procurement and Transplantation Network on the date of 
                enactment of this section, and the effect of the Organ 
                Transplant Program Reauthorization Act of 1993 on the 
                composition and functioning of such boards;
                    ``(B)(i) the number and percentage of cadaveric 
                organ transplants for foreign nationals and nonresident 
                aliens categorized by organ procurement organization 
                and by transplant center and information on any 
                reciprocal agreements between organ procurement 
                organizations and foreign countries or territories;
                    ``(ii) the number and percent of the organizations 
                referred to in clause (i) above the organ procurement 
                transplant network guideline of 10 percent; and
                    ``(III) any information on the current rate of 
                organ donation by individuals other than United States 
                citizens or legal residents;
                    ``(C) organ donation rates and the impact of 
                various organ allocation systems on organ procurement 
                rates; and
                    ``(D) the equitable allocation of organs 
                nationwide, including an analysis of the relative 
                probability of receiving an organ for patients with 
                similar characteristics for each category of 
                transplanted organ by organ procurement organization 
                and recommendations for developing a regional 
                allocation system in order to ensure that--
                            ``(i) patients in one region have an 
                        equivalent probability of receiving an organ as 
                        do patients with similar characteristics in 
                        another region; and
                            ``(ii) patients within a region have an 
                        equivalent probability of receiving an organ as 
                        do other patients with similar characteristics 
                        in that region.
            ``(2) Equitable allocation.--In carrying out paragraph (1) 
        with respect to subparagraph (D), the Comptroller General 
        shall--
                    ``(A) recommend regions for allocating organs to 
                encompass as large a geographic area as is practical, 
                taking into account medical appropriateness, and the 
                geographic proximity of patients with comparable 
                priority for receiving an organ;
                    ``(B) take into account the impact on organ 
                donation and procurement rates; and
            ``(C) consult with experts in the area of organ allocation 
        and organ donations and consider their recommendations 
        regarding the establishment of regions in the country for the 
        purpose of allocating organs.
    ``(b) Report.--Not later than 2 years after the date of enactment 
of the Organ Transplant Program Reauthorization Act of 1993, the 
Comptroller General of the United States shall complete the study 
required under subsection (a) and prepare 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.''.

SEC. 5. GENERAL PROVISIONS.

    (a) Limitation.--Section 374(b) of the Public Health Service Act 
(42 U.S.C. 274b(b)) is amended--
            (1) by striking paragraph (2);
            (2) by redesignating paragraph (3) as paragraph (2); and
            (3) in paragraph (2) (as so redesignated), by striking 
        ``371(a)(3)'' and inserting ``371(a)(2)''.
    (b) Repeal.--Section 376 of the Public Health Service Act (42 
U.S.C. 274d) is repealed.
    (c) Transfer.--Section 378 of the Public Health Service Act (42 
U.S.C. 274g) is amended--
            (1) by transferring such section to part H of title III; 
        and
            (2) by inserting such section after section 377.
    (d) Authorization of Appropriations.--Section 378 of the Public 
Health Service Act (42 U.S.C. 274g) is amended by striking ``1991'' and 
all that follows through the period and inserting ``1994, and such sums 
as may be necessary for each of the fiscal years 1995 and 1996.''.

SEC. 6. EFFECTIVE DATES.

    (a) In General.--Except as provided in subsection (b), the 
amendments made by this Act shall become effective on the date of 
enactment of this Act.
    (b) Exception.--The amendments made by section 2(b)(4)(C) shall 
become effective 9 months after the date of enactment of this Act. 
Prior to such date, section 371(b)(3)(E) of the Public Health Service 
Act, as in effect on the day before the date of the enactment of this 
Act, shall remain in effect.
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