HOUSE OF RE»
RECEIVED

DATE: 04 JUL 2015
Time: _ 975

WES

REPUBLIC OF THE PHILIPPINES
HOUSE OF REPRESENTATIVES
Quezon City

SEVENTEENTH CONGRESS
First Regular Session

832
HOUSE BILL No.

Introduced by Honorable Benhur B. Lopez Jr.
EXPLANATORY NOTE
Supply has not kept pace with demand

At the outset, Republic Act No. 7170 authorizes the legacy or donation of all
or part of a human body after death for specified purposes. The law recognizes
that an individual has the option to become a hero, so to speak, via a will or other
document he/she himself/herself executed or through the decision of his/her
next of kin, Hence, a mechanism has been set up to legitimize the donation of
organs to take effect after death.

Moreover, in fulfilment of the country’s commitment to the 63" World
Health Assembly and the Istanbul Declaration 2008, the government set up a
national system of promoting organ donation from deceased donors and sharing
of grafts through the Philippine Network for Organ Sharing or PHILNOS. The
network aims at implementing a system of timely referral and processing of
potential multiple organ donors, the equitable allocation and _ efficient
procurement and transplantation of organs from them. It bears stressing
however again that what presently is being promoted is only deceased organ
donation.

But, how about living organ donation?

To date, there is no law passed by Congress addressing this specific
concern. True, there is Republic Act No. 9208, otherwise known as the Anti-
Trafficking in Persons Act of 2003 which punishes the exploitative removal or
sale of organs as an act of trafficking. It thus raises the question: how about non-
exploitative removal of organs? Thus, a law is necessary to determine precisely
when is removal of organ considered exploitative or when it may be considered as
a valid act of donation.

The ratio between living and deceased donors cannot be over-emphasized.
Statistics' show that from 1999 to 2009, there has been an

x Philippine Renal Disease Registry; PRDR Annual Report, Philippine
Society of Nephrology and Renal Disease Control Program, National Kidney and
Transplant Institute, Department of Health, 2010



average of 178 (92.7%) living kidney donors as compared to 14 (7.3%) deceased
donors for Filipino recipients. Out of the 178,102 (or 57%) are living non-related
donors while 76 (or 43%) are living related donors. Meanwhile, there are 9,184
Filipinos suffering from end-stage renal diseases, and only 477 (or roughly 5%) of
whom have undergone kidney transplant? Globally, every year, a million people
develop end-stage renal disease but only a fraction of those receive any kind renal
placement therapy and even fewer receive kidney transplants*-In fact, currently,
there are 48 pay patients and 20 service patients on the active waiting list of the
Human Organ Preservation Effort of the National Kidney and Transplant
Institute (HOPE-NKTI), while there are 413 pay patients and 95 service patients
on the inactive waiting list on the same hospital4. Annually, 5 active pay patients,
3 active service patients, 10 inactive pay patients and 10 inactive service patients
die while on the waiting lists, For this reason, the demand for kidney donation is
high.

It is undeniable that there are other successful strategies to expand kidney
donor pool including passing presumed-consent law, use of non-heart beating
deceased donors, encouraging live donor renal transplantation from genetically-
related and emotionally-motivated donors, accepting non-directed kidney
donations. Trends, globally however, prove that the waiting list for renal
transplants has not significantly declined despite these efforts, with the single
exception of the latest strategy, meaning, accepting non-directed type of living
donation, which happened in Iran.

It is thus submitted that the availability of the source of the supply of
organs should not be restricted to deceased donors but should include living and
willing donors. It cannot be denied that living donors far outnumber the deceased
ones and this situation can be taken advantaged of, provided proper parameters
are observed. These parameters must, in the end, not only increase potential
donors but equally important is that, it must help curb or curtail illegal organ
commerce that only degrades the person of the donor but may also endanger
their very lives leading therefore to exploitation.

Ina country such as ours, culture and religion play important roles in
decision making. It is however submitted that becoming an organ or tissue donor
is a personal decision. A decision that must likewise be guided by the constant
fact that organ and tissue donation saves lives and that in no instance should
exploitation of either the donor or recipient be countenanced.

J For 2009

3 Dr. Luc Noel, Coordinator of WHO's clinical procedure team, as quoted in
WHO Bulletin entitled “Dilemma over live-donor transplantation”

4 Answer of HOPE-NKTI dated 30 September 2010 to query of the bill
proponent

5 ibid


This bill, in the higher interest of public health, therefore primarily ensures
that the availability of organs and tissues, for donation, from living and willing
donors, is carefully supervised and regulated. Supervision and regulation which
includes the grant of reasonable support to donors, to include medical care, or
educational, economic or livelihood projects, or other forms of assistance to
promote the well-being of these donors.

In view of the foregoing, the approval of this proposed measure is earnestly
sought.

OPEZ JR.
Party list, YACAP.


REPUBLIC OF THE PHILIPPINES
HOUSE OF REPRESENTATIVES
Quezon City

SEVENTEENTH CONGRESS
First Regular Session

HOUSE BILL No. 882

Introduced by Hon. Benhur B. Lopez Jr.

AN ACT REGULATING THE DONATION AND TRANSPLANTATION OF
HUMAN ORGANS AND TISSUES FROM LIVING DONORS

Be it enacted by the Senate and House of Representatives of the Philippines in
Congress assembled:

SECTION 1, Title. This act shall be known as “LIVING
ORGAN DONORS ACT of 2016.”
SECTION 2. Declaration of Policies. It is hereby declared

the policy of the State to promote and protect the health of its people and, in line
with this policy, the State shall enact measures creating programs including but
not limited to:

(A) Recognizing and regulating the donation of human organs and
tissues of living donors to prevent their exploitation and, more importantly,
ensure their legal entitlement to reasonable medical support and other forms of
assistance;

(B) Granting patients with end-stage diseases access to human
organs for transplantation but at the same time ensuring that there is equitable
distribution in the allocation of available organs among qualified recipients;

(Cc) Encouraging donation of human organs and tissues, most
especially the directed living donation, without giving endue prejudice to non-
directed directed living donation, and taking into consideration respect for the
dignity of human life, beneficence and non-maleficence, solidarity and
volunteerism, justice and equity;

(D) Developing and maintaining a national registry and reporting
system of donors and recipients of human organs and tissues, and the continuous
evaluation of the system.


SECTION 3. Definition of Terms. As used in this act, the
following terms shall have the following meanings:

“Human Organ or Tissue” refers to the kidney, liver, heart, lung,
pancreas, bone marrow, cornea, eye, bone, skin, nerve, muscle tissue and any
other human organ or tissue that may be transplanted to another living person.

“Donation of an organ or tissue” refers to a voluntary act of a person
to give his organs or tissues gratuitously in favor of another, who accepts it. In
this case, the recipient shall have no demandable or enforceable right over the
organ or tissue donated, but he may, after the donation has been performed and
in gratitude or acknowledgement of the donation, give anything of value to the
donor.

“Related Donors” refers to relatives by consanguinity up to the fourth civil
degree.

“Non-Related Donors” include the following:

(A) Those who are related by consanguinity beyond the fourth civil

degree;

(B) Those who are related within the fourth degree of affinity;

(C) Those not related by consanguinity or affinity but bear emotional
ties with the organ or tissue recipient (e.g. friends, employees or
employers, colleagues, fiance/fiancee); and

(D) Strangers.

“Directed living donors” — refer to a donor who has a specific recipient in
mind whom would want to donate to.

“Non-directed living donors” — refer to donors who would donate to
whoever matches on a list of waiting patients for organ transplant.

“Transplant Facility” — facility or hospital in which the transplant shall be
performed.

“Indigent” — refers to an individual who has been certified by the local
branch of the Department of Social Welfare and Development of the area in
which he/she is a resident to be belonging to that sector living or earning below
the poverty threshold as determined from time to time by the National Economic
and Development Authority.

“Medical care” — refers to medicines and laboratory examinations
necessary to be made for purposes of, and pursuant to, transplantation. It
however does not include expenses for the treatment of unrelated medical illness
that is discovered during evaluation procedures.

SECTION 4. Acceptable Living Donations — Any individual,
at least twenty one years of age, of sound mind, who underwent screening and
counselling procedures and has been found suitable as living donor based on the
physical and psychological evaluation and assessments made by the physicians of
the transplant facility who are not in anyway directly connected with the
transplant, and thus fully understands the risks, benefits and consequences of


transplanting organs and tissues from his/her body, may so donate by way of
written consent to such removal for purposes of transplanting the same to
another living human body. Such informed consent shall be in a document
witnessed by a relative of the donor and two (2) physicians neither of whom shall
be a member of the team of medical practitioners who will effect the removal of
the organ or tissue from the donor's body nor the physician or transplant team
attending to the recipient of the organ to be removed.

In no instance shall a minor be made a donor of any organ or tissue to
anybody. Further, no transplant shall be undertaken if it will result in a physical
and/or psychological harm to the donor. Furthermore, an individual is allowed to
donate only one organ/tissue in his/her lifetime. Finally, a foreigner is not
allowed to become a recipient of any organ/tissue unless it can be shown that
he/she is a former Filipino citizen or that the potential donor is related to the said
former Filipino foreigner by consanguinity within the fourth degree.

SECTION 5. Choice of type of donation — It shall be the
choice of the donor whether to make a non-directed or directed type of donation,
taking into consideration the following:

A. In making a non-directed type of living donation, a non-indigent
donor is to proceed to an accredited transplant facility of his/her
choice, bringing with him a verified certification from two (2)
physicians to the effect that he/she is physically and medically fit to
donate the organ of his/her choice. The said transplant facility shall
then conduct the required pre-transplant psychological screening to
determine his/her suitability for donation. The cost of the screening
shall be free of charge. It later on found suitable to make the
donation, the transplant facility shall then register the name of the
potential donor in the Philippine Organ Donor and Recipient
Registry System (PODRRS) maintained by the Department of Health
for matching with a recipient.

In a case of an indigent donor intending to make a non-directed
living donation, he/she shall proceed to an accredited government
transplant facility which shall conduct initially a psychological
screening, as adverted to in Section 4 hereof to determine his mental
fitness to make such a donation. If found suitable, the same
government transplant facility shall subject the potential donor to a
test to determine his physical fitness to undergo the donation. In
both cases of screening and physical testing, the procedure shall be
free of charge. If the potential donor is finally found psychologically,
mentally and physically fit to make the donation, his/her name shall
then be registered by the same transplant facility in the PODRRS for
matching with a recipient.

It is understood that a non-directed living donor makes such
donation out of mere altruism but a grateful recipient who after the
transplant, had knowledge of the identity of his/her donor, is not
precluded from giving financial assistance to the latter.

B. In making a directed type of living donation, the potential donor
shall undergo psychological, mental and physical tests to determine
his/her fitness to become a donor, the costs of all of which shall be


borne by the intended recipient, unless the recipient is an indigent in
which case the said tests shall be conducted free charge in the
government transplant facility in which the indigent is to be
scheduled for transplant.

SECTION 6. Requirement of registration - All patients in
need of transplant shall also register themselves in the Philippine Organ Donor
and Recipient Registry System (PODRRS) maintained by the Department of
Health (DOH).

SECTION 7. Duty of non-indigent recipients — In all cases of
living donation, whether directed or non-directed, and notwithstanding any
agreement to the contrary, it shall be the responsibility of the non-indigent
recipient to shoulder the cost of the transplantation procedure and pre and post-
operation medical care of the donor, who has been found suitable mentally and
physically to make the donation.

Further, the recipient shall cause the name of the donor to be registered in
the registry of the PODRRS. Furthermore, the recipient is obliged to shoulder the
expenses of travel and housing, if any, and lost wages, if applicable and other
related expenses in connection with the donation. Finally, the recipient shall be
made to answer financially, wholly or partly depending on their agreement, for
any subsequent disease that may be developed by the donor in connection with
the organ or tissue donated.

Nothing in this Act however shall proscribe the voluntary act of the
recipient in providing additional assistance to the family of the family of the
donor either through livelihood projects and/or educational support to the family
of the donor.

SECTION 8. Duty of the State —~ if the organ or tissue recipient
is indigent, as certified to by the local branch of the Department of Social Welfare
and Development of the area where the recipient is a resident, the actual
transplant shall be made in any of the accredited government transplant facilities
and the pre and post operation medical care of the donor shall be shouldered by
the said transplant facility while the expenses of travel and housing, if any, and
lost wages, if applicable, shall be shouldered by the local government of which the
recipient is a resident.

The local government unit concerned as well as the district representative
of the place where the donor is a resident shall likewise, as far as practicable,
provide preferential assistance in terms of educational, scholarship or other non-
monetary benefits to the family of the donor and/or his next of kin.

SECTION 9. Duty of donors — In all cases, it shall be the duty of
the donor, for his own protection, to ensure and verify that his name is registered
in the national registry of donors maintained by the PODRRS.

SECTION 10. Incentives for donors - An organ or tissue donor
shall be entitled to a leave of absence with pay for the period of his confinement
for purposes of actual transplantation and post-transplant recovery for a period
not to exceed fifteen (15) working days.


Should the donor develop a disability, as defined under the Social Security
and Government Service Insurance System charters, resulting from the
transplantation procedure, he/she shall be entitled to a disability pay, as therein
defined and computed.

Further, should the donor eventually develop a disease or sickness
necessitating a transplant, the said donor shall be given priority in the registry of
potential recipients.

Furthermore, airline companies are to provide at least 10% discount on
airfare of potential donors, on their way to and from the actual transplant
operation, who have been found suitable, mentally and physically to make the
donation.

Finally, pharmaceutical companies and their distributors are directed to
ensure that at least a 10% discount is likewise provided for post-transplant and
transplant-related medicines personally consumable by the donors.

SECTION 11. Unlawful Act. __ It is hereby declared unlawful and
punishable in its severest form any act of any third person tending to broken,
negotiate or engage in transactions that will lead or cause to be lead the
transplant of any organ from one person to another, whether for a fee or for free.

SECTION 12. Philippine Network for Organ Sharing — The
Department of Health-established Philippine Network for Organ Sharing
(PHILNOS) which promotes organ donation from deceased donors is hereby
recognized but in addition, it shall also come up with mechanisms and guidelines
on living organ donors, as herein provided.

The DOH shall report to Congress before June 30 of every year the analysis
of information derived from the registry.

SECTION 13. _ Regulatory Authority - The Department of Health shall
be responsible for:

(A) Implementing the provisions of this Act;

(B) Issuing guidelines relative to the process of donor-screening and
evaluation as well as donor and recipient pre and post transplant
counselling;

(C) Issuing guidelines on the accreditation of transplant facilities, whether
government or private, thereby ensuring that all necessary equipment
and facilities are available as well as guaranteeing that the transplant
team have the necessary expertise and experience in conducting the
same;

(D) Issuing guidelines relative to the duties of hospitals and their
respective physicians relative to the conduct of transplant and all its
necessary incidents.

SECTION 14. Penalties for Violation (A) A non-indigent recipient
who fails to perform any of the mandatory duties mentioned in Section 7 hereof
as well as the local chief executive and responsible officers of the local
government unit concerned, the officials and employees of hospitals and
companies directly involved under Section 8 and 10 respectively hereof shall be
held individually liable and suffer the following penalties:


() Fine of not less than One Hundred Thousand Pesos (100,000.00)
but not exceeding Five Hundred Thousand Pesos (P500,000.00) or
imprisonment of not less than one year but not more than five years, or
both, at the discretion of the Court.

(2) For any subsequent violation in case of public and private
corporations, a fine of not less than Two Hundred Thousand Pesos
(P200,000.00) but not exceeding Six Hundred Thousand Pesos
(P600,000.00) or imprisonment for not less than two years but not more
than six years, or both, at the discretion of the court.

Upon filing of an appropriate complaint, and after due notice and hearing,
the proper authorities may also cause the cancellation or revocation of the
business permit, permit to operate, franchise and other similar privileges
granted to any business entity that fails to abide by the provisions of this
Act.

(B) Any person found guilty of violating the provision of Section 11 hereof
shall be penalized with imprisonment for not less than six (6) years nor more
than twelve (12) years and fine in an amount not less than five hundred thousand
pesos (P500,000.00) nor more than one million pesos.

SECTION 15. Funding. An amount not exceeding annually is hereby
set aside from the charity funds of the Philippine Charity Sweepstakes Office to
cover the financial requirements of this Act.

SECTION 16. Repealing Clause. _ All Acts or parts of Acts, executive
orders and their implementing rules inconsistent with the provisions of this Act
are hereby repealed, amended or modified accordingly.

SECTION 17. Separability Clause. _If any provision of this Act is
declared invalid, the remainder of this Act or any provisions not affected thereby
shall remain in force and in effect.

SECTION 18. _Effectivity. This Act shall take effect after fifteen days
from publication in two newspapers of general circulation.