Anatomical Gifts

Creates a funding mechanism to educate the public about organ and
tissue donation.  Requires hospitals to report the suitability of
patients for organ and tissue donation.  (HB547 SD2)

HOUSE OF REPRESENTATIVES                H.B. NO.           H.D. 3
TWENTIETH LEGISLATURE, 1999                                S.D. 2
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 tissues 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 legislature finds and declares that public support of

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 1 education on organ, tissue, and eye donation is in the public's
 2 interest and for the public health, safety, and general welfare.
 3      The purpose of this Act is to increase the number of
 4 individuals being asked to donate organs, to expand educational
 5 efforts across all ethnic, religious, and age groups, to increase
 6 the supply of organs for waiting transplant recipients, and to
 7 create a special fund which will be used to promote public
 8 education programs on organ, tissue, and eye donation.
 9      SECTION 2.  Chapter 286, Hawaii Revised Statutes, is amended
10 by adding two new sections to be appropriately designated and to
11 read as follows:
12      "286-A  Organ and tissue education fee.  Notwithstanding
13 any other law to the contrary, beginning July 1, 2000, a donation
14 of $1, in addition to any other fees under this chapter, may be
15 collected upon designation by an individual or entity from each
16 certificate of registration by the director of finance of each
17 county to be deposited on a quarterly basis into the Hawaii organ
18 and tissue education special fund pursuant to section 327-B.
19      286-B  Limited access to driver's license anatomical gift
20 data.  The examiner of drivers shall adopt rules pursuant to
21 chapter 91 to allow an organ procurement organization
22 twenty-four-hour telephone access to the driver's license
23 database information, solely for the purpose of determining

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 1 whether a driver has indicated a willingness to be an organ donor
 2 pursuant to section 286-109.5.
 3      As used in this section, "organ procurement organization"
 4 shall have the same meaning as procurement organization in
 5 section 327-1."
 6      SECTION 3.  Chapter 327, Hawaii Revised Statutes, is amended
 7 by adding two new sections to be appropriately designated and to
 8 read as follows:
 9      "327-A  Required referral.  (a)  On or before the
10 occurrence of each death in an acute care hospital, the hospital
11 shall report to the local organ procurement organization in order
12 to determine the suitability of the individual for organ, tissue,
13 and eye donation.  This contact shall be noted on the patient's
14 medical record.
15      (b)  Each acute care hospital shall develop no later than
16 July 1, 2000, with the concurrence of the hospital medical staff,
17 a protocol for identifying potential organ and tissue donors.
18 The protocol shall require that at or near the time of every
19 individual death, the acute care hospital shall contact by
20 telephone the local organ procurement organization to determine
21 suitability for organ, tissue, and eye donation of the
22 individual.  Each hospital shall designate a person to contact
23 the local organ procurement organization to provide the

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 1 appropriate data about the individual necessary to begin
 2 assessment for suitability for recovery of anatomical gifts.  The
 3 acute care hospital's protocol shall specify the kind of
 4 information that shall be available prior to making the contact,
 5 including the patient's age and cause of death.
 6      The local organ procurement organization, in consultation
 7 with the patient's attending physician or designee, shall
 8 determine the suitability for donation.  If the local organ
 9 procurement organization in consultation with the patient's
10 attending physician or designee determines that donation is not
11 appropriate based on established medical criteria, this shall be
12 noted by the hospital personnel on the patient's record, and no
13 further action shall be necessary.  If the local organ
14 procurement organization in consultation with the patient's
15 attending physician or designee determines that the patient is a
16 suitable candidate for anatomical donation, the acute care
17 hospital and the local organ procurement organization, separately
18 or together, shall initiate a request by a designated requester,
19 who shall be a person trained by the local organ procurement
20 organization.  The protocol shall encourage discretion and
21 sensitivity to family circumstances in all discussions regarding
22 donations of tissue or organs.  The protocol shall take into
23 account the deceased individual's religious beliefs or

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 1 nonsuitability for organ and tissue donation.
 2      (c)  The local organ procurement organization shall conduct
 3 annual death record reviews at each acute care hospital to
 4 determine compliance with required referral.  There shall be no
 5 cost assessed against a hospital for a review of death records
 6 pursuant to this subsection.
 7      (d)  As used in this section:
 8      "Acute care hospital" means a hospital, as defined in
 9 section 327-1, other than a nursing facility or other long-term
10 care facility.
11      "Designated requester" means a person who has completed a
12 course offered by an organ procurement organization on how to
13 approach families and request organ or tissue donation.
14      "Organ procurement organization" shall have the same meaning
15 as procurement organization in section 327-1.
16      327-B  Hawaii organ and tissue education special fund.
17 There is established in the state treasury the Hawaii organ and
18 tissue education special fund.  Moneys collected under section
19 286-A shall be deposited into the fund.  The fund shall be
20 administered and distributed by the department of health and
21 shall be used exclusively for public education programs and
22 activities on organ, tissue, and eye donation."
23      SECTION 4.  Chapter 327, Hawaii Revised Statutes, is amended

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

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

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

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 1 subject to appropriate administrative sanctions."]
 2      SECTION 5.  The department of health, with the assistance of
 3 the Organ Donor Center of Hawaii, shall report to the legislature
 4 no later than twenty days prior to the convening of the Regular
 5 Session of 2003, on the deposits and disbursements of the Hawaii
 6 organ and tissue education special fund and on the effectiveness
 7 of that fund in achieving its purposes.
 8      SECTION 6.  There is appropriated out of the organ and
 9 tissue education special fund for fiscal year 2000-2001 the sum
10 of $          .  The sum appropriated shall be expended by the
11 department of health as a grant to the Organ Donor Center of
12 Hawaii for the purposes set forth in section 327-B, Hawaii
13 Revised Statutes.
14      SECTION 7.  In codifying the new sections added to chapters
15 286 and 327, Hawaii Revised Statutes, by sections 2 and 3 of this
16 Act, and referred to in this Act, the revisor of statutes shall
17 substitute appropriate section numbers for the letters used in
18 the new sections' designations in this Act.
19      SECTION 8.  Statutory material to be repealed is bracketed.
20 New statutory material is underscored.
21      SECTION 9.  This Act shall take effect on July 1, 2000;
22 provided that sections 286-A and 327-B, Hawaii Revised Statutes,
23 shall be repealed on June 30, 2003.