Anatomical Gifts

Amends Hawaii's Uniform Anatomical Gift Act to:  require all
acute care hospitals in Hawaii to report to the procurement
organization to determine suitability for organ donation;
requires the procurement organization and hospital
representatives to develop protocols for presenting the option to
donate; limits liability of any person who relies in good faith
on the document, except for gross negligence, recklessness, or
intentional misconduct; requires the OPO and hospital
representatives to conduct an annual death record review.  Allows
the voluntary donation of $1 towards an organ and tissue
education special fund and specifies allocation to specific
education categories.  (SD2)

THE SENATE                              S.B. NO.           S.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
11 appear to be at increased risk to suffer illnesses such as
12 diabetes, that destroy healthy organs and require replacement.
13 The chances of finding a good organ match is increased if the
14 donor is of the same ethnic group as the transplant recipient.
15 Minority ethnic groups must be educated in the great need among
16 their own people for anatomical gifts.  The legislature finds
17 that more education and discussion among families are necessary
18 to encourage organ donation.
19      The purpose of this Act is to increase the number of

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 1 patients being asked to donate organs, to expand educational
 2 efforts across all ethnic, religious, and age groups, and to
 3 increase the supply of organs for waiting transplant recipients.
 4      SECTION 2.  Chapter 286, Hawaii Revised Statutes, is amended
 5 by adding a new section to be appropriately designated and to
 6 read as follows:
 7      "286-A  Organ and tissue education fee.  Notwithstanding
 8 any other law to the contrary, a voluntary fee of $1 for each
 9 certificate of registration or driver's license application or
10 renewal shall be collected annually from July 1, 2000 by the
11 director of finance of each county, to be deposited into the
12 organ and tissue education special fund pursuant to section
13 327-C."
14      SECTION 3.  Chapter 327, Hawaii Revised Statutes, is amended
15 by adding four new sections to part IV to be appropriately
16 designated and to read as follows:
17      "327-A  Required referral.  (a)  On or before the
18 occurrence of each death in an acute care hospital, the hospital
19 shall report to the appropriate organ, tissue, or eye recovery
20 agency in order to determine the suitability of the individual
21 for organ, tissue, and eye donation.  This contact shall be noted
22 on the patient's medical record.
23      (b)  Each acute care hospital shall develop within one year

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                                     S.B. NO.           S.D. 2

 1 of the effective date of this section, with the concurrence of
 2 the hospital medical staff, a protocol for identifying potential
 3 organ and tissue donors.  The protocol shall require that at or
 4 near the time of every individual death, an acute care hospital
 5 shall contact by telephone the local procurement organization to
 6 determine suitability for organ, tissue, and eye donation of the
 7 individual in question.  Each hospital shall designate a person
 8 to contact the procurement organization along with the
 9 appropriate data about each affected individual necessary to
10 begin assessment for suitability for recovery of anatomical
11 gifts.  The acute care hospital's protocol shall specify the kind
12 of information that shall be available prior to making the
13 contact, including but not limited to the patient's age and cause
14 of death.  The procurement organization in consultation with the
15 patient's attending physician, or designee, shall determine the
16 suitability for donation.  If the procurement organization in
17 consultation with the patient's attending physician or designee
18 determines that donation is not appropriate based on established
19 medical criteria, this shall be noted by the hospital personnel
20 on the patient's record, and no further action shall be
21 necessary.  If the procurement organization in consultation with
22 the patient's attending physician or designee determines that the
23 patient is a suitable candidate for anatomical donation, the

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                                     S.B. NO.           S.D. 2

 1 acute care hospital and the procurement organization, separately
 2 or together, shall initiate a request by a designated requester
 3 who shall be a person trained by the procurement organization.
 4 The protocol shall encourage discretion and sensitivity to family
 5 circumstances in all discussions regarding donations of tissue or
 6 organs.  The protocol shall take into account the deceased
 7 individual's religious beliefs or nonsuitability for organ and
 8 tissue donation.  As used in this section, "designated requester"
 9 means a person who has completed a course offered by an
10 procurement organization on how to approach families and request
11 organ or tissue donation.
12      (c)  The procurement organization shall conduct annual death
13 record reviews at each acute care hospital to determine
14 compliance with required referrals; provided that the reviews
15 shall be at no cost to the hospital.
16      327-B  Organ and tissue education special fund.  (a)  The
17 Hawaii organ and tissue education special fund is established
18 effective July 1, 1999, in the state treasury and shall be
19 administered by the state department of health.  The fund shall
20 be used for educational purposes to promote organ, tissue, and
21 eye donation programs in schools and other public places
22 including motor vehicle registration offices, buses, libraries,
23 and government offices.

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                                     S.B. NO.           S.D. 2

 1      (b)  Moneys in the Hawaii organ and tissue education special
 2 fund shall be distributed to the Organ Donor Center of Hawaii
 3 which shall apportion the funds as follows:
 4      (1)  Thirty per cent for the minority organ tissue
 5           transplant education program;
 6      (2)  Twenty per cent to Hawaii's federally-designated
 7           procurement organization for the development of public
 8           education programs; and
 9      (3)  Fifty per cent to Hawaii's coalition of organ donation
10           related agencies for public education programs and
11           activities.
12      327-C  Good faith reliance.  A person, hospital, or
13 organization that relies on a document of gift under section
14 327-2(b) and acts in good faith in accordance with this chapter
15 shall not be subject to criminal or civil liability for any
16 action taken in accordance with the requirements of this chapter;
17 provided that this section shall not apply to gross negligence,
18 recklessness, or intentional misconduct towards the decedent."
19      SECTION 4.  Section 286-109.5, Hawaii Revised Statutes, is
20 amended to read as follows:
21      "286-109.5  Designation of anatomical gift[.]; access to
22 database.  (a)  The examiner of drivers shall design and
23 implement a system to request anatomical gift information from

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                                     S.B. NO.           S.D. 2

 1 all applicants for a driver's license or license renewal, at the
 2 time of application, including a method of directly imprinting on
 3 a license an applicant's designation of whether the applicant
 4 wishes to be an organ donor.  The request shall elicit whether
 5 the applicant wishes to be an organ donor in the event of the
 6 applicant's death.
 7      (b)  The examiner of drivers shall adopt rules pursuant to
 8 chapter 91 to allow an appropriate organ, tissue, and eye
 9 recovery agency or procurement organization as defined in section
10 327-1, twenty-four-hour telephone access to the drivers'
11 licensing database information, solely for the purpose of
12 determining whether a driver has indicated a willingness to be an
13 organ donor under subsection (a), if the information is requested
14 by a designated requester under section 327-A(b)."
15      SECTION 5.  Section 327-5, Hawaii Revised Statutes, is
16 repealed.
17      ["327-5  Routine inquiry and required request; search and
18 notification.(a)  On or before admission to a hospital, or as
19 soon as possible thereafter, a person designated by the hospital
20 shall ask each patient who is at least eighteen years of age:
21 "Are you an organ or tissue donor?"  If the answer is affirmative
22 the person shall request a copy of the document of gift.  The
23 person designated shall make available basic information

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                                     S.B. NO.           S.D. 2

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

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                                     S.B. NO.           S.D. 2

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

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                                     S.B. NO.           S.D. 2

 1 of the anatomical gift or release and removal of a part.
 2      (f)  A person who fails to discharge the duties imposed by
 3 this section is not subject to criminal or civil liability but is
 4 subject to appropriate administrative sanctions."]
 5      SECTION 6.  In codifying the new sections added to chapters
 6 286 and 327, Hawaii Revised Statutes, by sections 2 and 3 of this
 7 Act, respectively, the revisor of statutes shall substitute
 8 appropriate section numbers for the letters used in the new
 9 sections' designations in this Act.
10      SECTION 7.  Statutory material to be repealed is bracketed.
11 New statutory material is underscored.
12      SECTION 8.  This Act shall take effect upon its approval.