I 

117TH CONGRESS 

1ST SESSION H. R. 3569 

To amend the National Organ Transplant Act to clarify the definition of 

valuable consideration, to clarify that pilot programs that honor and 

promote organ donation do not violate that Act, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 28, 2021 

Mr. CARTWRIGHT (for himself, Mr. WILSON of South Carolina, Mr. COHEN, 

Mr. FITZPATRICK, Mr. KELLY of Pennsylvania, Mr. MCKINLEY, Mr. SAN

NICOLAS, Ms. SCHAKOWSKY, Mr. SCHIFF, Ms. SPEIER, Mr. TIMMONS, 

and Mr. YOUNG) introduced the following bill; which was referred to the 

Committee on Energy and Commerce 

A BILL 

To amend the National Organ Transplant Act to clarify 

the definition of valuable consideration, to clarify that 

pilot programs that honor and promote organ donation 

do not violate that Act, and for other purposes. 

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 ‘‘Organ Donation Clari5 fication Act of 2021’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds the following: 


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1 (1) As of March 2021, 108,000 people await an 

2 organ transplant, with 91,000 of those people wait3 ing for a kidney, and average wait times are ap4 proaching five years for a kidney, with over one-and5 a-half times as many people being added to the wait6 ing lists as getting a transplant. 

7 (2) Of the nearly three million Americans who 

8 die annually, under 30,000, representing about one 

9 percent of all deaths each year, possess major or10 gans healthy enough for transplanting. 

11 (3) On average, 17 people a day died while 

12 waiting for an organ in 2020, with the majority of 

13 those people waiting for a kidney. 

14 (4) In 2020, approximately 3,800 people were 

15 removed from kidney waiting lists and approximately 

16 1,600 from liver, heart, and lungs waiting lists be17 cause they became permanently too sick to receive a 

18 transplant. 

19 (5) Over 75 percent of dialysis patients are not 

20 employed because dialysis requires multiple treat21 ments per week which last several hours and leave 

22 patients drained, thus creating a huge financial bur23 den on the patients, their families, and the govern24 ment; moreover, lost tax revenue from these individ25 uals is not included in the cost estimates above. 


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1 (6) A patient receiving a kidney transplant, and 

2 thus no longer needing dialysis, can enjoy a much 

3 higher quality of life for another 10–15 years on av4 erage. 

5 (7) As medical advances extend people’s lives on 

6 dialysis, the number of patients on dialysis will in7 crease significantly, as will the costs for individuals 

8 and the Federal Government. 

9 (8) Roughly seven percent of the Medicare 

10 budget goes to the End Stage Renal Disease Pro11 gram, with dialysis costing Medicare over $90,000 

12 per patient per year, as Federal law dictates that 

13 Medicare will cover dialysis for everyone who has 

14 made minimal Social Security tax payments. 

15 (9) A kidney transplant pays for itself in less 

16 than two years, with each transplant saving an aver17 age of $146,000 in medical costs over a 10-year pe18 riod, 75 percent of which is savings to the taxpayers. 

19 (10) Experts project that if the supply of trans20 plant kidneys could be increased to meet the de21 mand, taxpayers would save more than 

22 $14,000,000,000 per year in medical costs. 

23 (11) The World Health Organization estimates 

24 that 10 percent of all transplants take place on the 

25 international black market, the last choice for desVerDate Sep 11 2014 05:42 Jun 22, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3569.IH H3569

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1 perate patients facing an alternative of death, how2 ever recipients often receive infected kidneys and 

3 suffer poor health outcomes and donors are often 

4 victimized. 

5 (12) Present policy on domestic donation has 

6 never been subject to studies or pilots to determine 

7 effectiveness in increasing the availability of donated 

8 organs and the effectiveness of safeguards that pre9 vent coercion or exploitation, precludes all but altru10 istic donation, prohibiting any form of incentive or 

11 benefit for donors. 

12 (13) In 2010, Israel implemented sweeping 

13 changes to its national organ donation program in14 cluding reducing financial burdens on donors, giving 

15 future transplantation priority to registered organ 

16 donors and their families, and promoting donation 

17 by reimbursing the donor’s medical costs, 40 days of 

18 lost wages, and five years of medical and life insur19 ance costs, and as a result saw organ donation ap20 proximately triple over a 10-year period. 

21 (14) Experts are arriving at a consensus that 

22 trials are necessary to find new methods of pro23 moting additional organ donation which will save 

24 lives and reduce organ trafficking. 


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1 SEC. 3. CLARIFICATION OF CERTAIN PROVISIONS OF THE 

2 NATIONAL ORGAN TRANSPLANT ACT. 

3 (a) RELATION TO OTHER LAWS.—Section 301 of the 

4 National Organ Transplant Act (42 U.S.C. 274e) is 

5 amended by adding at the end the following: 

6 ‘‘(d) RELATION TO OTHER LAWS.— 

7 ‘‘(1) GOVERNMENTS ENCOURAGING ORGAN DO8 NATION.—This section shall not— 

9 ‘‘(A) apply to actions taken by the Govern10 ment of the United States or any State, terri11 tory, tribe, or local government of the United 

12 States to carry out a covered pilot program; or 

13 ‘‘(B) prohibit acceptance of any noncash 

14 benefits provided by the pilot program under 

15 subparagraph (A). 

16 ‘‘(2) NO PROHIBITION ON OTHER BENEFITS

17 PROGRAMS.—Nothing in this subsection shall be con18 strued to prohibit actions, other than actions de19 scribed in this section, taken by any State, territory, 

20 tribe, or unit of local government in the United 

21 States to provide benefits for human organ donation. 

22 ‘‘(3) COVERED PILOT PROGRAM.—For purposes 

23 of this subsection— 

24 ‘‘(A) the term ‘covered pilot program’ 

25 means a pilot program approved by the Sec26 retary of Health and Human Services, subject 


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1 to an ethical review board process, with a term 

2 of not more than 5 fiscal years, for the purpose 

3 of measuring the effect of removing disincen4 tives or providing a noncash benefit that may 

5 increase the organ pool. Distributions of organs 

6 from deceased donors under the pilot program 

7 shall be conducted only through the Organ Pro8 curement and Transplantation Network at a 

9 transplant center approved by the United Net10 work for Organ Sharing or any other entity 

11 designated by the Secretary of Health and 

12 Human Services; and 

13 ‘‘(B) the term ‘noncash benefit’ means any 

14 benefit or thing of value received by an organ 

15 donor that is impossible to sell, trade, or other16 wise transfer to another individual.’’. 

17 (b) VALUABLE CONSIDERATION.—Section 301(c)(2) 

18 of the National Organ Transplant Act (42 U.S.C. 

19 274e(c)(2)) is amended to read as follows: 

20 ‘‘(2) The term ‘valuable consideration’ does not 

21 include the following: 

22 ‘‘(A) Reasonable payments associated with 

23 the removal, transportation, implantation, proc24 essing, preservation, quality control, and stor25 age of a human organ. 


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1 ‘‘(B) Reimbursement for travel, lodging, 

2 food during travel, and other logistical expenses 

3 related to donation. 

4 ‘‘(C) Provision of advanced payments or 

5 reimbursement for dependent care needs for 

6 pre-transplant appointments in addition to dur7 ing the period of donation and post-transplant 

8 follow-up care related to the donation for up to 

9 a 10-year period. 

10 ‘‘(D) Reimbursement for lost wages related 

11 to donation. 

12 ‘‘(E) Medical expenses related to donation 

13 and all related follow-up care including prevent14 ative follow-up care and medication for up to a 

15 10-year period. 

16 ‘‘(F) Paperwork or legal costs related to 

17 donation. 

18 ‘‘(G) Any term life insurance policy against 

19 the risk of death or disability as a result of do20 nating an organ or the longer-term health ef21 fects of having donated an organ, that— 

22 ‘‘(i) in the case of a life insurance pol23 icy, provides for payments in amounts less 

24 than $2,000,000, adjusted annually for in25 flation; and 


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1 ‘‘(ii) in the case of a disability insur2 ance policy, provides for payments equal to 

3 or less than the reasonable earnings expec4 tations of the donor.’’. 

Æ 


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