I 
115TH CONGRESS 
2D SESSION 
H. R. 6448 
To amend the National Organ Transplant Act to clarify the definition of 
valuable consideration, to clarify that pilot programs that honor and 
reward organ donation do not violate that Act, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 19, 2018 
Mr. CARTWRIGHT (for himself, Mr. LEWIS of Minnesota, Mr. COHEN, Mr. 
GRIJALVA, Ms. JENKINS of Kansas, Ms. EDDIE BERNICE JOHNSON of 
Texas, Mr. KHANNA, Mr. MARINO, Mr. POLIS, Mr. YOUNG of Alaska, Mr. 
BISHOP of Georgia, Mr. FITZPATRICK, Mr. POSEY, Mr. KELLY of Penn-
sylvania, Mr. MCGOVERN, and Mr. CARSON of Indiana) introduced the 
following bill; which was referred to the Committee on Energy and Com-
merce 
A BILL 
To amend the National Organ Transplant Act to clarify 
the definition of valuable consideration, to clarify that 
pilot programs that honor and reward organ donation 
do not violate that Act, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Organ Donation Clari-
fication Act of 2018’’. 
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SEC. 2. FINDINGS. 
Congress finds the following: 
(1) As of June 2018, 115,000 people await an 
organ transplant, with 95,000 of those people wait-
ing for a kidney, and average wait times are ap-
proaching five years for a kidney, with twice as 
many people being added to waiting lists as getting 
a transplant. 
(2) Living donor kidney transplants peaked in 
2004 and have declined since due to a scarcity of liv-
ing donors. 
(3) Of the roughly two million Americans who 
die annually, only 10,500 to 13,800, representing 
less than one percent of all deaths each year, possess 
major organs healthy enough for transplanting. 
(4) On average, 20 people a day died while 
waiting for an organ in 2017, with the majority of 
those people waiting for a kidney. 
(5) In 2017, 4,700 people were permanently re-
moved from kidney waiting lists and 1,800 from 
liver, heart, and lungs waiting lists because they be-
came permanently too sick to receive a transplant. 
(6) Ninety percent of dialysis patients are not 
employed because dialysis requires multiple treat-
ments per week which last several hours and leave 
patients drained, thus creating a huge financial bur-
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den on the patients, their families, and the govern-
ment which is not included in the cost estimates 
above, and which can help lead to as few as ten per-
cent of dialysis patients being employed. 
(7) A patient receiving a kidney transplant on 
average can go 10–15 years living without dialysis 
while enjoying a much higher quality of life. 
(8) As medical advances extend people’s lives on 
dialysis, the number of patients on dialysis will in-
crease significantly, as will the costs for individuals 
and the Federal Government. 
(9) Roughly seven percent of the Medicare 
budget goes to the End Stage Renal Disease Pro-
gram, with dialysis costing Medicare over $87,000 
per patient per year, as Federal law dictates that 
Medicare will cover dialysis for everyone who has 
made minimal Social Security tax payments. 
(10) A kidney transplant pays for itself in less 
than two years, with each transplant saving an aver-
age of over $700,000 in medical costs over a 10-year 
period, 85 percent of which is savings to the tax-
payers. 
(11) Experts project that if the supply of trans-
plant kidneys could be increased to meet the de-
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mand, 
taxpayers 
would 
save 
more 
than 
$12,000,000,000 per year in medical costs. 
(12) The World Health Organization estimates 
that 10 percent of all transplants take place on the 
international black market, the last choice for des-
perate patients facing an alternative of death, how-
ever recipients often face infected kidneys and have 
poor health outcomes and donors are often victim-
ized. 
(13) Present policy on domestic donation, which 
is not evidence based and has never been subject to 
studies or pilots to determine effectiveness in in-
creasing the availability of donated organs and the 
effectiveness of safeguards that prevent coercion or 
exploitation, precludes all but altruistic donation, 
prohibiting any form of incentive or benefit for do-
nors. 
(14) Experts are arriving at a consensus that 
trials are necessary to find new methods of pro-
moting additional organ donation which will save 
lives and reduce organ trafficking. 
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SEC. 3. CLARIFICATION OF CERTAIN PROVISIONS OF THE 
NATIONAL ORGAN TRANSPLANT ACT. 
(a) RELATION TO OTHER LAWS.—Section 301 of the 
National Organ Transplant Act (42 U.S.C. 274e) is 
amended by adding at the end the following: 
‘‘(d) RELATION TO OTHER LAWS.— 
‘‘(1) GOVERNMENTS ENCOURAGING ORGAN DO-
NATION.—This section shall not— 
‘‘(A) apply to actions taken by the Govern-
ment of the United States or any State, terri-
tory, tribe, or local government of the United 
States to carry out a covered pilot program; or 
‘‘(B) prohibit acceptance of any noncash 
benefits provided by the pilot program under 
subparagraph (A). 
‘‘(2) NO
PROHIBITION
ON
OTHER
BENEFITS 
PROGRAMS.—Nothing in this subsection shall be con-
strued to prohibit actions, other than actions de-
scribed in this section, taken by any State, territory, 
tribe, or unit of local government in the United 
States to provide benefits for human organ donation. 
‘‘(3) COVERED PILOT PROGRAM.—For purposes 
of this subsection, the term ‘covered pilot program’ 
means a pilot program approved by the Secretary of 
Health and Human Services, subject to an ethical 
review board process, with a term of not more than 
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5 fiscal years, for the purpose of measuring the ef-
fect of removing disincentives or providing a noncash 
benefit that may increase the organ pool. Distribu-
tions of organs from deceased donors under the pilot 
program shall be conducted only through the Organ 
Procurement and Transplantation Network at a 
transplant center approved by the United Network 
for Organ Sharing or any other entity designated by 
the Secretary of Health and Human Services.’’. 
(b) VALUABLE CONSIDERATION.—Section 301(c)(2) 
of the National Organ Transplant Act (42 U.S.C. 
274e(c)(2)) is amended to read as follows: 
‘‘(2) The term ‘valuable consideration’ does not 
include the following: 
‘‘(A) Reasonable payments associated with 
the removal, transportation, implantation, proc-
essing, preservation, quality control, and stor-
age of a human organ. 
‘‘(B) Reimbursement for travel, lodging, 
food during travel, and other logistical expenses 
related to donation. 
‘‘(C) Provision of advanced payments or 
reimbursement for dependent care needs for 
pre-transplant appointments in addition to dur-
ing the period of donation and post-transplant 
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follow up care related to the donation for up to 
a 10-year period. 
‘‘(D) Reimbursement for lost wages related 
to donation. 
‘‘(E) Medical expenses related to donation 
and all related follow-up care including prevent-
ative follow-up care and medication for up to a 
10-year period. 
‘‘(F) Paperwork or legal costs related to 
donation. 
‘‘(G) Any term life insurance policy against 
the risk of death or disability as a result of do-
nating an organ or the longer term health ef-
fects of having donated an organ, that— 
‘‘(i) in the case of a life insurance pol-
icy, provides for payments in amounts 
greater than $2,000,000, adjusted annu-
ally for inflation; and 
‘‘(ii) in the case of a disability insur-
ance policy, provides for payments beyond 
the reasonable earnings expectations of the 
donor.’’. 
Æ 
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