Anatomical Gifts

Amends Hawaii's Uniform Anatomical Gift Act to:
(1) Require all acute care hospitals in Hawaii at or near the
time of every individual death, to report to the organ
procurement organization (OPO) by telephone to determine
suitability for organ donation of the individual in question;
(2) Require the OPO and hospital representatives to
cooperatively develop protocols for presenting the option to
(3) Limits liability of any person who relies in good faith on
the document of gift, except for gross negligence, recklessness,
or intentional misconduct;
(4) Require the OPO to conduct an annual death record review;
(5) Establish a state organ donation advisory committee; and
(6) Authorize the Lt. Governor to actively promote organ,
tissue, and other anatomical gift efforts. (HB547 HD1)

HOUSE OF REPRESENTATIVES                H.B. NO.           H.D. 1
TWENTIETH LEGISLATURE, 1999                                
STATE OF HAWAII                                            

                   A  BILL  FOR  AN  ACT



 1      SECTION 1.  The legislature finds that there exists in the
 2 State a shortage of organ and tissue donors to provide the organs
 3 and tissue that could save lives or enhance the quality of life
 4 for many persons.  There are many more patients on the waiting
 5 list for a kidney, liver, heart, lung, or other solid organs than
 6 there are donated organs.  As a result, many patients die before
 7 they can be given a second chance at life.
 8      The legislature further finds that particular difficulties
 9 exist in making members of various minority groups aware of the
10 need for anatomical gifts.  For various reasons minorities appear
11 to be at increased risk to suffer illnesses, such as diabetes,
12 that destroy healthy organs and require replacement.  The chances
13 of finding a good organ match is increased if the donor is of the
14 same ethnic group as the transplant recipient.  Minority ethnic
15 groups must be educated in the great need among their own people
16 for anatomical gifts.  The legislature finds that more education
17 and discussion among families are necessary to encourage organ
18 donation.

Page 2                                                     547
                                     H.B. NO.           H.D. 1

 1      The purpose of this Act is to increase the number of
 2 patients being asked to donate organs, to expand educational
 3 efforts across all ethnic, religious, and age groups, and to
 4 increase the supply of organs for waiting transplant recipients.
 5      SECTION 2.  Chapter 286, Hawaii Revised Statutes, is amended
 6 by adding two new sections to be appropriately designated and to
 7 read as  follows:
 8      "286-A  Organ and tissue education fee.  Notwithstanding
 9 any other law to the contrary, a voluntary fee of $1 for each
10 certificate of registration or driver's license application or
11 renewal shall be collected annually by the director of finance of
12 each county, to be deposited into the Hawaii organ and tissue
13 education special fund pursuant to section 327-C.
14      286-B  Limited access to driver's license anatomical gift
15 data.  The examiner of drivers shall adopt rules pursuant to
16 chapter 91 to allow an appropriate organ, tissue, and eye
17 recovery agency or organ procurement organization to twenty-four-
18 hour telephone access to the driver's license database
19 information, solely for the purpose of determining whether a
20 driver has indicated a willingness to be an organ donor pursuant
21 to section 286-109.5 when the information is requested pursuant
22 to section 327-A."

Page 3                                                     547
                                     H.B. NO.           H.D. 1

 1      SECTION 3.  Chapter 327, Hawaii Revised Statutes, is amended
 2 by adding three new sections to be appropriately designated and
 3 to read as follows:
 4      "327-A  Required referral.  (a)  On or before the
 5 occurrence of each death in an acute care hospital, the hospital
 6 shall report to the appropriate organ, tissue, or eye recovery
 7 agency in order to determine the suitability of the individual
 8 for organ, tissue, and eye donation.  This contact shall be noted
 9 on the patient's medical record.
10      (b)  Each acute care hospital shall develop within one year
11 of the effective date of this Act, with the concurrence of the
12 hospital medical staff, a protocol for identifying potential
13 organ and tissue donors.  The protocol shall require that at or
14 near the time of every individual death, an acute care hospital
15 shall contact by telephone the local organ procurement
16 organization to determine suitability for organ, tissue, and eye
17 donation of the individual in question.  Each hospital shall
18 designate a person to contact the organ procurement organization
19 along with the appropriate data about each affected individual
20 necessary to begin assessment for suitability for recovery of
21 anatomical gifts.  The acute care hospital's protocol shall
22 specify the kind of information that shall be available prior to
23 making the contact, including but not limited to the patient's
24 age and cause of death.

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                                     H.B. NO.           H.D. 1

 1      The organ procurement organization, in consultation with the
 2 patient's attending physician or designee, shall determine the
 3 suitability for donation.  If the organ procurement organization
 4 in consultation with the patient's attending physician or
 5 designee determines that donation is not appropriate based on
 6 established medical criteria, this shall be noted by the hospital
 7 personnel on the patient's record, and no further action shall be
 8 necessary.  If the organ procurement organization in consultation
 9 with the patient's attending physician or designee determines
10 that the patient is a suitable candidate for anatomical donation,
11 the acute care hospital and the organ procurement organization,
12 separately or together, shall initiate a request by a designated
13 requester who shall be a person trained by the organ procurement
14 organization.  The protocol shall encourage discretion and
15 sensitivity to family circumstances in all discussions regarding
16 donations of tissue or organs.  The protocol shall take into
17 account the deceased individual's religious beliefs or
18 nonsuitability for organ and tissue donation.
19      As used in this section, "designated requester" means a
20 person who has completed a course offered by an organ procurement
21 organization on how to approach families and request organ or
22 tissue donation.

Page 5                                                     547
                                     H.B. NO.           H.D. 1

 1      (c)  The organ procurement organization shall conduct annual
 2 death record reviews at each acute care hospital to determine
 3 compliance with required referral.  There shall be no cost
 4 assessed against a hospital for a review of death records
 5 pursuant to this subsection.
 6      327-B  Advisory committee on anatomical gifts.  (a)  There
 7 is established within the department of health for administrative
 8 purposes the advisory committee on anatomical gifts.  The
 9 committee shall consist of at least twenty members but not more
10 than twenty-five members appointed by the governor as provided in
11 section 26-34.  Members shall serve without compensation but
12 shall be reimbursed for expenses, including travel expenses,
13 necessary for the performance of their duties.  There shall be at
14 least one member representing each of the following categories:
15      (1)  Transplant physicians;
16      (2)  Organ donor center of Hawaii;
17      (3)  Hawaii lions eye bank and Makana foundation;
18      (4)  Minority organ tissue transplant education program;
19      (5)  St. Francis transplant center;
20      (6)  National kidney foundation of Hawaii;
21      (7)  Hawaii medical association;
22      (8)  Hawaii nurses' association;
23      (9)  American heart association;

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                                     H.B. NO.           H.D. 1

 1      (10) Hawaii healthcare association;
 2      (11) Donor family members;
 3      (12) Transplant recipients international organization;
 4      (13) Transplant candidates;
 5      (14) Clergy;
 6      (15) Department of education;
 7      (16) Department of health; and
 8      (17) Representatives of the general public, including but
 9           not limited to individuals from the fields of law,
10           theology, ethics, health care financing, the social and
11           behavioral sciences, and labor and management unrelated
12           to the field of health care.
13      Every effort shall be made to select members from every
14 island and from rural and urban areas for maximum geographic
15 representation.  Members shall serve for four years and may be
16 removed for incompetence or misconduct.  A majority of the
17 members then serving shall constitute a quorum.  Members shall
18 select their own chairperson who shall serve for two years.
19      (b)  The committee shall meet at least semiannually or at
20 the call of the chairperson to:
21      (1)  Promote educational programs to increase awareness of
22           organ donation needs; and

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                                     H.B. NO.           H.D. 1

 1      (2)  Engage in any other information, educational, and
 2           promotional efforts that will help to increase organ,
 3           tissue, and eye donation.
 4      (c)  The lieutenant governor shall be the primary government
 5 official to promote organ donation awareness and shall serve as
 6 an ex officio member of the advisory committee.  The lieutenant
 7 governor shall assist in any way to promote educational programs
 8 to promote organ donation.
 9      327-C  Hawaii organ and tissue education special fund.  (a)
10 The Hawaii organ and tissue education special fund is established
11 in the state treasury and shall be administered by the office of
12 the lieutenant governor.  The fund shall be used for educational
13 purposes to promote organ, tissue, and eye donation programs in
14 schools and other public places including motor vehicle
15 registration offices, buses, libraries, and government offices.
16      (b) Moneys in the Hawaii organ and tissue education special
17 fund shall be apportioned as follows:
18      (1)  Thirty per cent to the minority organ tissue transplant
19           education program;
20      (2)  Twenty per cent to the local organ procurement
21           organization for the development of public education
22           programs; and

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                                     H.B. NO.           H.D. 1

 1      (3)  Fifty per cent to Hawaii's coalition of organ donation
 2           related agencies for public education programs and
 3           activities."
 4      SECTION 4.  Chapter 327, Hawaii Revised Statutes is amended
 5 as follows:
 6      1.  By amending subsection (h) of section 327-2 to read:
 7      "(h)  An anatomical gift that is not revoked by the donor
 8 before death is irrevocable and does not require the consent or
 9 concurrence of any person after the donor's death.
10      Any person, hospital, or organization that relies on the
11 document of gift and acts in good faith in accordance with the
12 provisions of this chapter shall not be subject to criminal or
13 civil liability from any action taken under this chapter.  The
14 immunity provided by this subsection shall not extend to such
15 person, hospital, or organization if damages result from the
16 gross negligence, recklessness, or intentional misconduct to the
17 decedent."
18      2.  By repealing section 327-5.
19      ["327-5  Routine inquiry and required request; search and
20 notification.(a)  On or before admission to a hospital, or as
21 soon as possible thereafter, a person designated by the hospital
22 shall ask each patient who is at least eighteen years of age:
23 "Are you an organ or tissue donor?"  If the answer is affirmative

Page 9                                                     547
                                     H.B. NO.           H.D. 1

 1 the person shall request a copy of the document of gift.  The
 2 person designated shall make available basic information
 3 regarding the option to make or refuse to make an anatomical
 4 gift.  The answer to the question, an available copy of any
 5 document of gift or refusal, if any, to make an anatomical gift,
 6 and any other relevant information, shall be placed in the
 7 patient's medical record.
 8      (b)  If, at or near the time of death of a patient, there is
 9 no medical record that the patient has made or refused to make an
10 anatomical gift, the hospital administrator or a representative
11 designated by the administrator shall discuss the option to make
12 or refuse to make an anatomical gift and request the making of an
13 anatomical gift pursuant to section 327-3.  The request shall be
14 made with reasonable discretion and sensitivity to the
15 circumstances of the family including a reciprocal beneficiary.
16 A request is not required if the gift is not suitable, based upon
17 accepted medical standards, for a purpose specified in section
18 327-6.  An entry shall be made in the medical record of the
19 patient, stating the name and affiliation of the individual
20 making the request, and of the name, response, and relationship
21 to the patient of the person to whom the request was made.  The
22 director of health may adopt rules to implement this subsection.

Page 10                                                    547
                                     H.B. NO.           H.D. 1

 1      (c)  The following persons shall, at the person's discretion
 2 and if time and resources permit, and if doing so would be
 3 inoffensive to anyone in the vicinity of the body, make a
 4 reasonable search of the person and the person's immediate
 5 personal effects for a document of gift or other information
 6 identifying the bearer as a donor or as an individual who has
 7 refused to make an anatomical gift:
 8      (1)  A law enforcement officer, firefighter, paramedic, or
 9           other emergency rescuer attending an individual who the
10           searcher believes to be dead or near death; and
11      (2)  A hospital, upon the admission of an individual at or
12           near the time of death, if there is not immediately
13           available any other source of that information.
14      (d)  If a document of gift or evidence of refusal to make an
15 anatomical gift is located by the search required by subsection
16 (c)(1), and the individual or body to whom it relates is taken to
17 a hospital, the hospital shall be notified of the contents and
18 the document or other evidence shall be sent to the hospital.
19      (e)  If, at or near the time of death of a patient, a
20 hospital knows that an anatomical gift has been made pursuant to
21 section 327-3 or a release and removal of a part has been
22 permitted pursuant to section 327-4, or that a patient or an
23 individual identified as in transit to the hospital is a donor,

Page 11                                                    547
                                     H.B. NO.           H.D. 1

 1 the hospital shall notify the donee if one is named and known to
 2 the hospital; if not, it shall notify an appropriate procurement
 3 organization.  The hospital shall cooperate in the implementation
 4 of the anatomical gift or release and removal of a part.
 5      (f)  A person who fails to discharge the duties imposed by
 6 this section is not subject to criminal or civil liability but is
 7 subject to appropriate administrative sanctions."]
 8      SECTION 5.  In codifying the new sections added to chapter
 9 327, Hawaii Revised Statutes, by sections 2 and 3 of this Act,
10 the revisor of statutes shall substitute appropriate section
11 numbers for the letters used in the new sections' designations in
12 this Act.
13      SECTION 6.  Statutory material to be repealed is bracketed.
14 New statutory material is underscored.
15      SECTION 7.  This Act shall take effect upon its approval.