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 HD2)

HOUSE OF REPRESENTATIVES                H.B. NO.           H.D. 2
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.
19      The purpose of this Act is to increase the number of
20 patients being asked to donate organs, to expand educational

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                                     H.B. NO.           H.D. 2

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

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                                     H.B. NO.           H.D. 2

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

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                                     H.B. NO.           H.D. 2

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

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                                     H.B. NO.           H.D. 2

 1 assessed against a hospital for a review of death records
 2 pursuant to this subsection.
 3      327-B  Advisory committee on anatomical gifts.  (a)  There
 4 is established within the department of health for administrative
 5 purposes the advisory committee on anatomical gifts.  The
 6 committee shall consist of at least twenty members but not more
 7 than twenty-five members appointed by the governor as provided in
 8 section 26-34.  Members shall serve without compensation but
 9 shall be reimbursed for expenses, including travel expenses,
10 necessary for the performance of their duties.  There shall be at
11 least one member representing each of the following categories:
12      (1)  Transplant physicians;
13      (2)  Organ donor center of Hawaii;
14      (3)  Hawaii lions eye bank and Makana foundation;
15      (4)  Minority organ tissue transplant education program;
16      (5)  St. Francis transplant center;
17      (6)  National kidney foundation of Hawaii;
18      (7)  Hawaii medical association;
19      (8)  Hawaii nurses' association;
20      (9)  American heart association;
21      (10) Hawaii healthcare association;
22      (11) Donor family members;
23      (12) Transplant recipients international organization;

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                                     H.B. NO.           H.D. 2

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

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                                     H.B. NO.           H.D. 2

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

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                                     H.B. NO.           H.D. 2

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

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                                     H.B. NO.           H.D. 2

 1 patient's medical record.
 2      (b)  If, at or near the time of death of a patient, there is
 3 no medical record that the patient has made or refused to make an
 4 anatomical gift, the hospital administrator or a representative
 5 designated by the administrator shall discuss the option to make
 6 or refuse to make an anatomical gift and request the making of an
 7 anatomical gift pursuant to section 327-3.  The request shall be
 8 made with reasonable discretion and sensitivity to the
 9 circumstances of the family including a reciprocal beneficiary.
10 A request is not required if the gift is not suitable, based upon
11 accepted medical standards, for a purpose specified in section
12 327-6.  An entry shall be made in the medical record of the
13 patient, stating the name and affiliation of the individual
14 making the request, and of the name, response, and relationship
15 to the patient of the person to whom the request was made.  The
16 director of health may adopt rules to implement this subsection.
17      (c)  The following persons shall, at the person's discretion
18 and if time and resources permit, and if doing so would be
19 inoffensive to anyone in the vicinity of the body, make a
20 reasonable search of the person and the person's immediate
21 personal effects for a document of gift or other information
22 identifying the bearer as a donor or as an individual who has
23 refused to make an anatomical gift:

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                                     H.B. NO.           H.D. 2

 1      (1)  A law enforcement officer, firefighter, paramedic, or
 2           other emergency rescuer attending an individual who the
 3           searcher believes to be dead or near death; and
 4      (2)  A hospital, upon the admission of an individual at or
 5           near the time of death, if there is not immediately
 6           available any other source of that information.
 7      (d)  If a document of gift or evidence of refusal to make an
 8 anatomical gift is located by the search required by subsection
 9 (c)(1), and the individual or body to whom it relates is taken to
10 a hospital, the hospital shall be notified of the contents and
11 the document or other evidence shall be sent to the hospital.
12      (e)  If, at or near the time of death of a patient, a
13 hospital knows that an anatomical gift has been made pursuant to
14 section 327-3 or a release and removal of a part has been
15 permitted pursuant to section 327-4, or that a patient or an
16 individual identified as in transit to the hospital is a donor,
17 the hospital shall notify the donee if one is named and known to
18 the hospital; if not, it shall notify an appropriate procurement
19 organization.  The hospital shall cooperate in the implementation
20 of the anatomical gift or release and removal of a part.
21      (f)  A person who fails to discharge the duties imposed by
22 this section is not subject to criminal or civil liability but is
23 subject to appropriate administrative sanctions."]

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                                     H.B. NO.           H.D. 2

 1      SECTION 5.  In codifying the new sections added to chapter
 2 327, Hawaii Revised Statutes, by sections 2 and 3 of this Act,
 3 the revisor of statutes shall substitute appropriate section
 4 numbers for the letters used in the new sections' designations in
 5 this Act.
 6      SECTION 6.  Statutory material to be repealed is bracketed.
 7 New statutory material is underscored.
 8      SECTION 7.  This Act shall take effect upon its approval.