II 

118TH CONGRESS 

1ST SESSION S. 1183 

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

cases of organ transplants. 

IN THE SENATE OF THE UNITED STATES 

APRIL 18, 2023 

Mr. RUBIO (for himself and Ms. HASSAN) introduced the following bill; which 

was read twice and referred to the Committee on Health, Education, 

Labor, and Pensions 

A BILL 

To prohibit discrimination on the basis of mental or physical 

disability in cases of 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 the following: 

8 (1) The Americans with Disabilities Act of 

9 1990, section 504 of the Rehabilitation Act of 1973, 

10 and section 1557 of the Patient Protection and AfVerDate Sep 11 2014 22:36 Apr 20, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S1183.IS S1183

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1 fordable Care Act prohibit discrimination against in2 dividuals with disabilities in organ transplantation 

3 and the allocation of organs. 

4 (2) Despite those prohibitions, there are find5 ings and cases that show, as is documented by the 

6 National Council on Disability and others, that indi7 viduals with disabilities are being denied organ 

8 transplants and related services based solely on the 

9 fact that those individuals have a disability. 

10 (3) 34 States have crafted State-level policy to 

11 prohibit organ transplant discrimination against in12 dividuals with disabilities. Federal action, however, 

13 is required to protect individuals with disabilities 

14 and to enforce existing law regardless of the State 

15 in which they live. 

16 (4) The current situation, with continuing cases 

17 of discrimination against individuals with disabil18 ities, calls for further clarity by Congress about 

19 which actions constitute discrimination under cur20 rent law, which entities are covered, and the rem21 edies available to individuals experiencing potential 

22 discrimination. 

23 (5) Licensed providers of health care services 

24 that provide organ transplants and related services 

25 in exchange for medical fees are engaging in an ecoVerDate Sep 11 2014 22:36 Apr 20, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1183.IS S1183

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1 nomic transaction with patients that occurs in or 

2 substantially impacts interstate commerce. 

3 (6) In the national administration of organ allo4 cation in the United States, organs are transported 

5 across State lines for transplantation procedures. 

6 (7) Discrimination in organ transplantation 

7 limits individuals with disabilities from participating 

8 in health care transactions in a manner that allows 

9 equal access to interstate commerce. 

10 (8) The existence of discrimination against indi11 viduals with disabilities in the provision of organ 

12 transplantation and related services burdens the flow 

13 of organs through legal channels of interstate com14 merce. 

15 SEC. 3. DEFINITIONS. 

16 In this Act: 

17 (1) AUXILIARY AIDS AND SERVICES.—The term 

18 ‘‘auxiliary aids and services’’ includes— 

19 (A) qualified interpreters or other effective 

20 methods of making aurally delivered materials 

21 available to individuals with a hearing impair22 ment; 

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

24 effective methods of making visually delivered 


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1 materials available to individuals with a visual 

2 impairment; 

3 (C) information in a format that is acces4 sible for individuals with a cognitive, neuro5 logical, developmental, or intellectual disability; 

6 (D) supported decision-making services; 

7 and 

8 (E) acquisition or modification of equip9 ment or devices. 

10 (2) COVERED ENTITY.—The term ‘‘covered en11 tity’’ means any licensed provider of health care 

12 services (including licensed health care practitioners, 

13 hospitals, nursing facilities, laboratories, inter14 mediate care facilities, psychiatric residential treat15 ment facilities, institutions for individuals with intel16 lectual or developmental disabilities, and prison 

17 health centers), and any transplant hospital (as de18 fined in section 121.2 of title 42, Code of Federal 

19 Regulations or a successor regulation), that— 

20 (A) is in interstate commerce; or 

21 (B) provides health care services in a man22 ner that— 

23 (i) substantially affects or has a sub24 stantial relation to interstate commerce; or 


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1 (ii) includes use of an instrument (in2 cluding an instrument of transportation or 

3 communication) of interstate commerce. 

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

5 meaning given the term in section 3 of the Ameri6 cans with Disabilities Act of 1990 (42 U.S.C. 

7 12102). 

8 (4) HUMAN ORGAN.—The term ‘‘human organ’’ 

9 has the meaning given the term in section 301(c) of 

10 the National Organ Transplant Act (42 U.S.C. 

11 274e(c)). 

12 (5) MATCHING ENTITY.—The term ‘‘matching 

13 entity’’ means an entity described in section 4. 

14 (6) ORGAN TRANSPLANT.—The term ‘‘organ 

15 transplant’’ means the transplantation or trans16 fusion of a donated human organ into the body of 

17 another human for the purpose of treating a medical 

18 condition. 

19 (7) QUALIFIED INDIVIDUAL.—The term ‘‘quali20 fied individual’’ means an individual who, with or 

21 without a support network, provision of auxiliary 

22 aids and services, or reasonable modifications to 

23 policies or practices, meets eligibility requirements 

24 for the receipt of a human organ. 


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1 (8) REASONABLE MODIFICATIONS TO POLICIES

2 OR PRACTICES.—The term ‘‘reasonable modifications 

3 to policies or practices’’ includes— 

4 (A) communication with persons respon5 sible for supporting a qualified individual with 

6 postsurgical or other care following an organ 

7 transplant or related services, including support 

8 with medication; and 

9 (B) consideration, in determining whether 

10 a qualified individual will be able to comply 

11 with health requirements following an organ 

12 transplant or receipt of related services, of sup13 port networks available to the qualified indi14 vidual, including family, friends, and providers 

15 of home and community-based services, includ16 ing home and community-based services funded 

17 through the Medicare or Medicaid program 

18 under title XVIII or XIX, respectively, of the 

19 Social Security Act (42 U.S.C. 1395 et seq., 

20 1396 et seq.), another health plan in which the 

21 qualified individual is enrolled, or any program 

22 or source of funding available to the qualified 

23 individual. 


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1 (9) RELATED SERVICES.—The term ‘‘related 

2 services’’ means services related to an organ trans3 plant that consist of— 

4 (A) evaluation; 

5 (B) counseling; 

6 (C) treatment, including postoperative 

7 treatment, and care; 

8 (D) provision of information; and 

9 (E) any other service recommended or re10 quired by a physician. 

11 (10) SECRETARY.—The term ‘‘Secretary’’ 

12 means the Secretary of Health and Human Services. 

13 (11) SUPPORTED DECISION MAKING.—The term 

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

15 support person to assist a qualified individual in 

16 making health care decisions, communicate informa17 tion to the qualified individual, or ascertain a quali18 fied individual’s wishes. Such term includes— 

19 (A) the inclusion of the individual’s attor20 ney-in-fact or health care proxy, or any person 

21 of the individual’s choice, in communications 

22 about the individual’s health care; 

23 (B) permitting the individual to designate 

24 a person of the individual’s choice for the pur25 poses of supporting that individual in commuVerDate Sep 11 2014 22:36 Apr 20, 2023 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1183.IS S1183

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1 nicating, processing information, or making 

2 health care decisions; 

3 (C) providing auxiliary aids and services 

4 described in subparagraph (A), (B), (C), or (E) 

5 of paragraph (1) to facilitate the individual’s 

6 ability to communicate and process health-re7 lated information, including providing use of as8 sistive communication technology; 

9 (D) providing health information to per10 sons designated by the individual, consistent 

11 with the regulations promulgated under section 

12 264(c) of the Health Insurance Portability and 

13 Accountability Act of 1996 (42 U.S.C. 1320d– 

14 2 note) and other applicable laws and regula15 tions governing disclosure of health informa16 tion; 

17 (E) providing health information in a for18 mat that is readily understandable by the indi19 vidual; and 

20 (F) working with a court-appointed guard21 ian or other person responsible for making 

22 health care decisions on behalf of the individual, 

23 to ensure that the individual is included in deci24 sions involving the health care of the individual 


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1 and that health care decisions are in accordance 

2 with the individual’s own expressed interests. 

3 (12) SUPPORT NETWORK.—The term ‘‘support 

4 network’’ means, with respect to a qualified indi5 vidual, one or more people who are— 

6 (A) selected by the qualified individual or 

7 by the qualified individual and the guardian of 

8 the qualified individual, to provide assistance to 

9 the qualified individual or guidance to that 

10 qualified individual in understanding issues, 

11 making plans for the future, or making complex 

12 decisions; and 

13 (B) who may include the family members, 

14 friends, unpaid supporters, members of the reli15 gious congregation, and appropriate personnel 

16 at a community center, of or serving the quali17 fied individual. 

18 SEC. 4. PROHIBITION OF DISCRIMINATORY POLICY. 

19 An entity who receives a contract under section 372 

20 of the Public Health Service Act (42 U.S.C. 274) to match 

21 human organs and individuals, and otherwise carry out 

22 the functions described in subsection (b) of that section, 

23 shall not issue policies, recommendations, or other memo24 randa that would prohibit, or otherwise hinder, a qualified 


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1 individual’s access to an organ transplant solely on the 

2 basis of that individual’s disability. 

3 SEC. 5. PROHIBITION OF DISCRIMINATION. 

4 (a) IN GENERAL.—Subject to subsection (b), a cov5 ered entity may not, solely on the basis of a qualified indi6 vidual’s disability— 

7 (1) determine that the individual is ineligible to 

8 receive an organ transplant or related services; 

9 (2) deny the individual an organ transplant or 

10 related services; 

11 (3) refuse to refer the individual to an organ 

12 transplant center or other related specialist for the 

13 purpose of receipt of an organ transplant or other 

14 related services; or 

15 (4) refuse to place the individual on an organ 

16 transplant waiting list. 

17 (b) EXCEPTION.— 

18 (1) IN GENERAL.— 

19 (A) MEDICALLY SIGNIFICANT DISABIL20 ITIES.—Notwithstanding subsection (a), a cov21 ered entity may take a qualified individual’s 

22 disability into account when making a health 

23 care treatment or coverage recommendation or 

24 decision, solely to the extent that the disability 

25 has been found by a physician, following an inVerDate Sep 11 2014 22:36 Apr 20, 2023 Jkt 039200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S1183.IS S1183

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1 dividualized evaluation of the potential recipi2 ent, to be medically significant to the receipt of 

3 the organ transplant or related services, as the 

4 case may be. 

5 (B) CONSTRUCTION.—Subparagraph (A) 

6 shall not be construed to require a referral or 

7 recommendation for, or the performance of, a 

8 medically inappropriate organ transplant or 

9 medically inappropriate related services. 

10 (2) CLARIFICATION.—If a qualified individual 

11 has the necessary support network to provide a rea12 sonable assurance that the qualified individual will 

13 be able to comply with health requirements following 

14 an organ transplant or receipt of related services, as 

15 the case may be, the qualified individual’s inability 

16 to independently comply with those requirements 

17 may not be construed to be medically significant for 

18 purposes of paragraph (1). 

19 (c) REASONABLE MODIFICATIONS.—A covered entity 

20 shall make reasonable modifications to policies or practices 

21 (including procedures) of such entity if such modifications 

22 are necessary to make an organ transplant or related serv23 ices available to qualified individuals with disabilities, un24 less the entity can demonstrate that making such modiVerDate Sep 11 2014 22:36 Apr 20, 2023 Jkt 039200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S1183.IS S1183

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1 fications would fundamentally alter the nature of such 

2 policies or practices. 

3 (d) CLARIFICATIONS.— 

4 (1) NO DENIAL OF SERVICES BECAUSE OF AB5 SENCE OF AUXILIARY AIDS AND SERVICES.—For 

6 purposes of this section, a covered entity shall take 

7 such steps as may be necessary to ensure that a 

8 qualified individual with a disability is not denied a 

9 procedure associated with the receipt of an organ 

10 transplant or related services, because of the absence 

11 of auxiliary aids and services, unless the covered en12 tity can demonstrate that taking such steps would 

13 fundamentally alter the nature of the procedure 

14 being offered or would result in an undue burden on 

15 the entity. 

16 (2) COMPLIANCE WITH OTHER LAW.—Nothing 

17 in this section shall be construed— 

18 (A) to prevent a covered entity from pro19 viding organ transplants or related services at 

20 a level that is greater than the level that is re21 quired by this section; or 

22 (B) to limit the rights of an individual with 

23 a disability under, or to replace or limit the 

24 scope of obligations imposed by, the Americans 

25 with Disabilities Act of 1990 (42 U.S.C. 12101 


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1 et seq.) including the provisions added to such 

2 Act by the ADA Amendments Act of 2008, sec3 tion 504 of the Rehabilitation Act of 1973 (29 

4 U.S.C. 794), section 1557 of the Patient Pro5 tection and Affordable Care Act (42 U.S.C. 

6 18116), or any other applicable law. 

7 (e) ENFORCEMENT.— 

8 (1) IN GENERAL.—Any individual who alleges 

9 that a qualified individual was subject to a violation 

10 of this section by a covered entity— 

11 (A) may bring a claim regarding the alle12 gation to the Office for Civil Rights of the De13 partment of Health and Human Services, for 

14 expedited resolution; and 

15 (B) whether or not such a claim is brought 

16 under subparagraph (A) or a violation is found 

17 pursuant to subparagraph (A), may bring a 

18 civil action in a district court of the United 

19 States for injunctive or other equitable relief, 

20 including the relief described in paragraph (2), 

21 against such covered entity to obtain compli22 ance of such covered entity with this section. 

23 (2) RELIEF AVAILABLE.—The injunctive and 

24 equitable relief available in a civil action brought 


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1 under paragraph (1)(B), with respect to a covered 

2 entity, includes— 

3 (A) requiring auxiliary aids and services to 

4 be made available by the entity involved; 

5 (B) requiring reasonable modifications to 

6 policies or practices (including procedures) of 

7 such entity; or 

8 (C) requiring that a facility of such entity 

9 be made readily accessible and usable. 

10 (3) EXPEDITED REVIEW.—In the case of a civil 

11 action brought under paragraph (1)(B), with respect 

12 to a covered entity, the district court in which such 

13 action is brought shall advance on its docket and ex14 pedite review and disposition of such action. 

15 (4) RULE OF CONSTRUCTION.—Nothing in this 

16 subsection is intended to limit or replace available 

17 remedies under the Americans with Disabilities Act 

18 of 1990 (42 U.S.C. 12101 et seq.) or any other ap19 plicable law. 

20 SEC. 6. APPLICATION TO EACH PART OF PROCESS. 

21 The provisions of this Act— 

22 (1) that apply to an organ transplant, also 

23 apply to the evaluation and listing of a qualified in24 dividual, and to the organ transplant and postVerDate Sep 11 2014 22:36 Apr 20, 2023 Jkt 039200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\S1183.IS S1183

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1 organ-transplant treatment of such an individual; 

2 and 

3 (2) that apply to related services, also apply to 

4 the process for receipt of related services by such an 

5 individual. 

6 SEC. 7. EFFECT ON OTHER LAWS. 

7 Nothing in this Act shall be construed to supersede 

8 any provision of any State or local law that provides great9 er rights to qualified individuals with respect to organ 

10 transplants than the rights established under this Act. 

Æ 


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