Republic of the Philippines
HOUSE OF REPRESENTATIVES
Quezon City

SIXTEENTH CONGRESS
First Regular Session

HOUSE BILL fo. 593

Introduced by Honorable Carol Jayne B. Lopez
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 ergan 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

1 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 of 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 of the same hospital’. Annually, 5 active
pay patients, 3 active service patients, 10 inactive pay patients and 10
inactive service patients die while on the waiting list’. 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.

itis 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 not only degrades the
person of the donor but may also endanger their very lives leading therefore
to exploitation.

In a 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.

2 For 2009

3 Dr. Luc Noel, Coordinator of WHO’s clinical procedure team, as
quoted in WHO Bulletin entitled “Dilemma over live-donor transpiantation”
4 4 Answer of HOPE-NKTI dated 30 September 2010 to query of the bill
proponent

s 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 profosed measure is
earnestly sought.

‘AROL JAYNE B. LOPEZ
farty list, YACAP


Republic of the Philippines
HOUSE OF REPRESENTATIVES
Quezon City

SIXTEENTH CONGRESS
First Regular Session

593

109"
HOUSE BILL NO.

Introduced by Hon. Carol Jayne B. Lopez =

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 shali be known as “LIVING ORGAN
DONORS ACT OF 2013.”

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;

(©) Encouraging donation of human organs and tissues, most
especially the directed living donation, without giving undue 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 aci, 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” inctade 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 he 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 fo, 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, ne 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. If 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 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 of 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 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 shali 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 weil 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, resuiting 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 @ 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 transpiant-related medicines personally consumable by the
donors.


SECTION 11. Unlawful act. !t is hereby declared unlawful and
punishable in its severest form any act of any third person tending to
broker, 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 aii
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 Sections 8 and 10 respectively hereof
shall be held individually liable and suffer the following penalties:

(1) Fine of not less than One Hundred Thousand Pesos
(P100,000.00) 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 Scction 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 fifieen days
from publication in two newspapers of general circulation.