I 
118TH CONGRESS 
1ST SESSION H. R. 4343 
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 
JUNE 23, 2023 
Ms. MATSUI (for herself and Mr. WILSON of South Carolina) 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. 
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 2023’’. 
SEC. 2. FINDINGS. 
Congress finds the following: 
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(1) As of May 2023, 113,999 people await an 
organ transplant, with 95,957 of those people wait-
ing for a kidney, and average wait times are ap-
proaching five years for a kidney, with over one-and- 
a-half times as many people being added to the wait-
ing lists as getting a transplant. 
(2) Of the nearly three million Americans who 
die annually, under 30,000, representing about one 
percent of all deaths each year, possess major or-
gans healthy enough for transplanting. 
(3) On average, 17 people a day died while 
waiting for an organ in 2020, with the majority of 
those people waiting for a kidney. 
(4) In 2022, approximately 4,498 people were 
removed from kidney waiting lists and approximately 
1,500 from liver (1,123), heart (239), and lungs 
(145) waiting lists because they became permanently 
too sick to receive a transplant. 
(5) Over 75 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-
den on the patients, their families, and the govern-
ment; moreover, lost tax revenue from these individ-
uals is not included in the cost estimates above. 
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(6) A patient receiving a kidney transplant, and 
thus no longer needing dialysis, can enjoy a much 
higher quality of life for another 10–15 years on av-
erage. 
(7) 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. 
(8) Roughly seven percent of the Medicare 
budget goes to the End Stage Renal Disease Pro-
gram, with dialysis costing Medicare over $90,000 
per patient per year, as Federal law dictates that 
Medicare will cover dialysis for everyone who has 
made minimal Social Security tax payments. 
(9) A kidney transplant pays for itself in less 
than two years, with each transplant saving an aver-
age of $136,000 in medical costs over a 10-year pe-
riod, 75 percent of which is savings to the taxpayers. 
(10) Experts project that if the supply of trans-
plant kidneys could be increased to meet the de-
mand, 
taxpayers 
would 
save 
more 
than 
$16,000,000,000 per year in medical costs. 
(11) The World Health Organization estimates 
that 10 percent of all transplants take place on the 
international black market, the last choice for des-
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