Organ Donation Clarification Act of 2021
Bill: H.R.3569 | Sponsor: Rep. Cartwright, Matt (D-PA)
Policy area: Health

Summary:
Organ Donation Clarification Act of 2021
This bill specifies that certain payments and pilot programs relating to organ donation do not violate the National Organ Transplant Act, which prohibits the exchange of valuable consideration for human organs.
Specifically, it excludes additional types of reimbursements and payments related to organ donation from the definition of valuable consideration, such as costs for (1) dependent care; (2) certain medical expenses for up to 10 years after a donation; (3) paperwork or legal services; and (4) term life insurance policies, subject to some limitations.
In addition, the federal government, states, or local governments may carry out pilot programs to evaluate the effects of removing disincentives or providing noncash benefits on the availability of organs for transplant, provided these programs meet ethical and other conditions.

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 Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Organ Donation Clarification Act of 
2021''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) As of March 2021, 108,000 people await an organ 
        transplant, with 91,000 of those people waiting for a kidney, 
        and average wait times are approaching five years for a kidney, 
        with over one-and-a-half times as many people being added to 
        the waiting 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 organs 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 2020, approximately 3,800 people were removed from 
        kidney waiting lists and approximately 1,600 from liver, heart, 
        and lungs 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 treatments per week which 
        last several hours and leave patients drained, thus creating a 
        huge financial burden on the patients, their families, and the 
        government; moreover, lost tax revenue from these individuals 
        is not included in the cost estimates above.
            (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 average.
            (7) As medical advances extend people's lives on dialysis, 
        the number of patients on dialysis will increase 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 Program, 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 average of $146,000 in 
        medical costs over a 10-year period, 75 percent of which is 
        savings to the taxpayers.
            (10) Experts project that if the supply of transplant 
        kidneys could be increased to meet the demand, taxpayers would 
        save more than $14,000,000,000 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 desperate patients facing an 
        alternative of death, however recipients often receive infected 
        kidneys and suffer poor health outcomes and donors are often 
        victimized.
            (12) Present policy on domestic donation has never been 
        subject to studies or pilots to determine effectiveness in 
        increasing 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 donors.
            (13) In 2010, Israel implemented sweeping changes to its 
        national organ donation program including reducing financial 
        burdens on donors, giving future transplantation priority to 
        registered organ donors and their families, and promoting 
        donation by reimbursing the donor's medical costs, 40 days of 
        lost wages, and five years of medical and life insurance costs, 
        and as a result saw organ donation approximately triple over a 
        10-year period.
            (14) Experts are arriving at a consensus that trials are 
        necessary to find new methods of promoting additional organ 
        donation which will save lives and reduce organ trafficking.

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 donation.--This section 
        shall not--
                    ``(A) apply to actions taken by the Government of 
                the United States or any State, territory, 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 construed to prohibit actions, 
        other than actions described 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--
                    ``(A) 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 5 fiscal years, 
                for the purpose of measuring the effect of removing 
                disincentives or providing a noncash benefit that may 
                increase the organ pool. Distributions 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; and
                    ``(B) the term `noncash benefit' means any benefit 
                or thing of value received by an organ donor that is 
                impossible to sell, trade, or otherwise transfer to 
                another individual.''.
    (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, processing, 
                preservation, quality control, and storage 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 during the 
                period of donation and post-transplant 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 preventative 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 donating an 
                organ or the longer-term health effects of having 
                donated an organ, that--
                            ``(i) in the case of a life insurance 
                        policy, provides for payments in amounts less 
                        than $2,000,000, adjusted annually for 
                        inflation; and
                            ``(ii) in the case of a disability 
                        insurance policy, provides for payments equal 
                        to or less than the reasonable earnings 
                        expectations of the donor.''.
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