II 

117TH CONGRESS 

1ST SESSION S. 3301 

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

cases of organ transplants. 

IN THE SENATE OF THE UNITED STATES 

DECEMBER 2, 2021 

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 00:32 Dec 08, 2021 Jkt 029200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S3301.IS S3301

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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) More than 25 States have crafted State11 level policy to prohibit organ transplant discrimina12 tion against individuals with disabilities. Federal ac13 tion, however, is required to protect individuals with 

14 disabilities and to enforce existing law regardless of 

15 the State 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 00:32 Dec 08, 2021 Jkt 029200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S3301.IS S3301

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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 in the national administration of organ alloca5 tion in the United States, with organs being trans6 ported across State lines for transplantation proce7 dures. 

8 (7) Discrimination in organ transplantation 

9 limits individuals with disabilities from participating 

10 in health care transactions in a manner that allows 

11 equal access to interstate commerce. 

12 (8) The existence of discrimination against indi13 viduals with disabilities in the provision of organ 

14 transplantation and related services burdens the flow 

15 of organs through legal channels of interstate com16 merce. 

17 SEC. 3. DEFINITIONS. 

18 In this Act: 

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

20 ‘‘auxiliary aids and services’’ includes— 

21 (A) qualified interpreters or other effective 

22 methods of making aurally delivered materials 

23 available to individuals with a hearing impair24 ment; 


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

2 effective methods of making visually delivered 

3 materials available to individuals with a visual 

4 impairment; 

5 (C) information in a format that is acces6 sible for individuals with a cognitive, neuro7 logical, developmental, or intellectual disability; 

8 (D) supported decisionmaking services; 

9 and 

10 (E) acquisition or modification of equip11 ment or devices. 

12 (2) COVERED ENTITY.—The term ‘‘covered en13 tity’’ means— 

14 (A) any licensed provider of health care 

15 services, including licensed health care practi16 tioners, hospitals, nursing facilities, labora17 tories, intermediate care facilities, psychiatric 

18 residential treatment facilities, institutions for 

19 individuals with intellectual or developmental 

20 disabilities, and prison health centers, that— 

21 (i) is in interstate commerce; or 

22 (ii) provides health care services in a 

23 manner that— 


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1 (I) substantially affects or has a 

2 substantial relation to interstate com3 merce; or 

4 (II) includes use of an instru5 ment (including an instrument of 

6 transportation or communication) of 

7 interstate commerce; or 

8 (B) any transplant center or entity respon9 sible for matching human organ donors to po10 tential recipients that is in interstate commerce, 

11 or that provides the matching services in a 

12 manner described in subparagraph (A)(ii). 

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

14 meaning given the term in section 3 of the Ameri15 cans with Disabilities Act of 1990 (42 U.S.C. 

16 12102). 

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

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

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

20 274e(c)). 

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

22 transplant’’ means the transplantation or trans23 fusion of a donated human organ into the body of 

24 another human for the purpose of treating or curing 

25 a medical condition. 


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1 (6) QUALIFIED INDIVIDUAL.—The term ‘‘quali2 fied individual’’ means an individual who, with or 

3 without a support network, provision of auxiliary 

4 aids and services, or reasonable modifications to 

5 policies or practices, meets eligibility requirements 

6 for the receipt of a human organ. 

7 (7) REASONABLE MODIFICATIONS TO POLICIES

8 OR PRACTICES.—The term ‘‘reasonable modifications 

9 to policies or practices’’ includes— 

10 (A) communication with individuals re11 sponsible for supporting an individual with 

12 postsurgical or other care following an organ 

13 transplant or related services, including support 

14 with medication; and 

15 (B) consideration, in determining whether 

16 an individual will be able to comply with health 

17 requirements following an organ transplant or 

18 receipt of related services, of support networks 

19 available to the individual, including family, 

20 friends, and providers of home and community21 based services, including home and community22 based services funded through the Medicare or 

23 Medicaid program under title XVIII or XIX, re24 spectively, of the Social Security Act (42 U.S.C. 

25 1395 et seq., 1396 et seq.), another health plan 


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1 in which the individual is enrolled, or any pro2 gram or source of funding available to the indi3 vidual. 

4 (8) RELATED SERVICES.—The term ‘‘related 

5 services’’ means services related to an organ trans6 plant that consist of— 

7 (A) evaluation; 

8 (B) counseling; 

9 (C) treatment, including postoperative 

10 treatment, and care; 

11 (D) provision of information; and 

12 (E) any other service recommended or re13 quired by a physician. 

14 (9) SECRETARY.—The term ‘‘Secretary’’ means 

15 the Secretary of Health and Human Services. 

16 (10) SUPPORTED DECISIONMAKING.—The term 

17 ‘‘supported decisionmaking’’ means the use of a sup18 port person to assist an individual in making health 

19 care decisions, communicate information to the indi20 vidual, or ascertain an individual’s wishes. Such 

21 term includes— 

22 (A) the inclusion of the individual’s attor23 ney-in-fact or health care proxy, or any person 

24 of the individual’s choice, in communications 

25 about the individual’s health care; 


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1 (B) permitting the individual to designate 

2 a person of the individual’s choice for the pur3 poses of supporting that individual in commu4 nicating, processing information, or making 

5 health care decisions; 

6 (C) providing auxiliary aids and services 

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

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

9 ability to communicate and process health-re10 lated information, including providing use of as11 sistive communication technology; 

12 (D) providing health information to per13 sons designated by the individual, consistent 

14 with the regulations promulgated under section 

15 264(c) of the Health Insurance Portability and 

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

17 2 note) and other applicable laws and regula18 tions governing disclosure of health informa19 tion; 

20 (E) providing health information in a for21 mat that is readily understandable by the indi22 vidual; and 

23 (F) working with a court-appointed guard24 ian or other individual responsible for making 

25 health care decisions on behalf of the individual, 


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1 to ensure that the individual is included in deci2 sions involving the health care of the individual 

3 and that health care decisions are in accordance 

4 with the individual’s own expressed interests. 

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

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

7 more individuals who are— 

8 (A) selected by the person or by the person 

9 and the guardian of the person, to provide as10 sistance to that person or guidance to that per11 son in understanding issues, making plans for 

12 the future, or making complex 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 per17 son. 

18 SEC. 4. PROHIBITION OF DISCRIMINATION. 

19 (a) IN GENERAL.—Subject to subsection (b), a cov20 ered entity may not, solely on the basis of a qualified indi21 vidual’s mental or physical disability— 

22 (1) determine that the individual is ineligible to 

23 receive an organ transplant or related services; 

24 (2) deny the individual an organ transplant or 

25 related services; 


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

2 transplant center or other related specialist for the 

3 purpose of receipt of an organ transplant or other 

4 related services; 

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

6 transplant waiting list, or place the individual at a 

7 lower-priority position on the list than the position 

8 at which the individual would have been placed if not 

9 for the disability of the individual; or 

10 (5) decline insurance coverage for the individual 

11 for any procedure associated with the receipt of an 

12 organ transplant or for related services, which proce13 dure or services, respectively, would be covered 

14 under such insurance for such individual if not for 

15 the disability of the individual. 

16 (b) EXCEPTION.— 

17 (1) IN GENERAL.— 

18 (A) MEDICALLY SIGNIFICANT DISABIL19 ITIES.—Notwithstanding subsection (a), a cov20 ered entity may take a qualified individual’s 

21 physical or mental disability into account when 

22 making a health care treatment or coverage rec23 ommendation or decision, solely to the extent 

24 that the disability has been found by a physi25 cian, following an individualized evaluation of 


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1 the potential recipient, to be medically signifi2 cant to the receipt of the organ transplant or 

3 related services, as the case may be. 

4 (B) CONSTRUCTION.—Subparagraph (A) 

5 shall not be construed to require a referral or 

6 recommendation for, or the performance of, a 

7 medically inappropriate organ transplant or 

8 medically inappropriate related services. 

9 (2) CLARIFICATION.—If a qualified individual 

10 has the necessary support network to provide a rea11 sonable assurance that the individual will be able to 

12 comply with health requirements following an organ 

13 transplant or receipt of related services, as the case 

14 may be, the individual’s inability to independently 

15 comply with those requirements may not be con16 strued to be medically significant for purposes of 

17 paragraph (1). 

18 (c) REASONABLE MODIFICATIONS.—A covered entity 

19 shall make reasonable modifications to policies or practices 

20 (including procedures) of such entity if such modifications 

21 are necessary to make an organ transplant or related serv22 ices available to qualified individuals with disabilities, un23 less the entity can demonstrate that making such modi24 fications would fundamentally alter the nature of such 

25 policies or practices. 


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1 (d) CLARIFICATIONS.— 

2 (1) NO DENIAL OF SERVICES BECAUSE OF AB3 SENCE OF AUXILIARY AIDS AND SERVICES.—A cov4 ered entity shall take such steps as may be nec5 essary to ensure that a qualified individual with a 

6 disability is not denied a procedure associated with 

7 the receipt of an organ transplant or related serv8 ices, and insurance coverage for the individual is not 

9 declined for a procedure or services described in sec10 tion 4(a)(5), because of the absence of auxiliary aids 

11 and services, unless the entity can demonstrate that 

12 taking such steps would fundamentally alter the na13 ture of the procedure or services being offered or 

14 would result in an undue burden on the entity. 

15 (2) COMPLIANCE WITH OTHER LAW.—Nothing 

16 in this Act shall be construed— 

17 (A) to prevent a covered entity from pro18 viding organ transplants or related services at 

19 a level that is greater than the level that is re20 quired by this section; or 

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

22 a disability under, or to replace or limit the 

23 scope of obligations imposed by, the Americans 

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

25 et seq.) including the provisions added to such 


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1 Act by the ADA Amendments Act of 2008, sec2 tion 504 of the Rehabilitation Act of 1973 (29 

3 U.S.C. 794), section 1557 of the Patient Pro4 tection and Affordable Care Act (42 U.S.C. 

5 18116), or any other applicable law. 

6 (3) APPLICATION TO EACH PART OF PROC7 ESS.—The provisions of this section apply to each 

8 part of the organ transplant process and the process 

9 for receipt of related services. 

10 SEC. 5. ENFORCEMENT. 

11 (a) IN GENERAL.—Any individual who alleges that 

12 a qualified individual was subject to a violation of section 

13 4 by a covered entity— 

14 (1) may bring a claim regarding the allegation 

15 to the Office for Civil Rights of the Department of 

16 Health and Human Services, for expedited resolu17 tion; and 

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

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

20 to paragraph (1), may bring a civil action in a dis21 trict court of the United States for injunctive or 

22 other equitable relief, including the relief described 

23 in subsection (b), against such covered entity to ob24 tain compliance of such covered entity with such sec25 tion. 


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1 (b) RELIEF AVAILABLE.—The injunctive and equi2 table relief available in a civil action brought under sub3 section (a)(2), with respect to a covered entity, includes— 

4 (1) requiring auxiliary aids and services to be 

5 made available by such entity; 

6 (2) requiring reasonable modifications to poli7 cies or practices (including procedures) of such enti8 ty; or 

9 (3) requiring that a facility of such entity be 

10 made readily accessible and usable. 

11 (c) EXPEDITED REVIEW.—In the case of a civil ac12 tion brought under subsection (a)(2), with respect to a 

13 covered entity, the district court in which such action is 

14 brought shall advance on its docket and expedite review 

15 and disposition of such action. 

16 (d) RULE OF CONSTRUCTION.—Nothing in this sec17 tion is intended to limit or replace available remedies 

18 under the Americans with Disabilities Act of 1990 or any 

19 other applicable law. 

20 SEC. 6. EFFECT ON OTHER LAWS. 

21 Nothing in this Act shall be construed to supersede 

22 any provision of any State or local law that provides great23 er rights to qualified individuals with respect to organ 

24 transplants than the rights established under this Act. 

Æ 


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