BILL ANALYSIS SENATE TRANSPORTATION & HOUSING COMMITTEE BILL NO: SB 1395 SENATOR ALAN LOWENTHAL, CHAIRMAN AUTHOR: alquist VERSION: 4/5/10 Analysis by: Carrie Cornwell FISCAL: yes Hearing date: April 13, 2010 SUBJECT: Organ and tissue donation DESCRIPTION: This bill requires that a person applying for or renewing a California Driver's License or identification card indicate whether or not he or she will be an organ donor, and it also authorizes creation of a living donor registry to sign up kidney donors. ANALYSIS: Existing law authorizes California's federally-designated organ procurement organizations (OPOs) to establish a not-for-profit organization to be designated the California Organ and Tissue Donation Registrar (registrar). The OPOs established Donate Life California as the registrar, and Donate Life California established and maintains the California Organ and Tissue Donor Registry (registry). Under current law, DMV must ask all applicants for original or renewal drivers' licenses or identification cards if they want to become organ and tissue donors. On the front of the application, DMV provides space to give consent to be an organ and tissue donor upon death. The application includes a statement on the back explaining that this consent is legally binding for those 18 and older and that minors require consent from a parent or guardian. An applicant need not answer in order to receive a driver's license or identification card . DMV prints the word "DONOR" inside a pink dot embedded on the face of the driver's license or identification card of each SB 1395 (ALQUIST) Page 2 person who signs up and transmits the person's information to Donate Life California. A person who applies for a driver's license or identification card may also designate a voluntary contribution of $2 to support organ and tissue donation. DMV collects these contributions, from which it deducts its actual administrative costs of signing up donors, and then DMV transmits the remainder to support the work of Donate Life California. This bill : 1.Requires an applicant for a driver's license or identification card to check yes or no as to whether to add his or her name to the organ donor registry. An applicant must answer this question in order to receive or renew his or her driver's license or identification card. 2.Requires DMV to update its driver's license and identification card applications to include yes or no check boxes specifically stating "Yes, add my name to the donor registry" or "I do not wish to register at this time." DMV shall also provide a prescribed explanation on the application of what checking yes means and information on how to remove one's name from the registry later by contacting Donate Life. 3.Rewrites the information that DMV shall provide on the back of the driver's license or identification card application to clarify that if the applicant is 18 or older, he or she has actually signed up by checking yes on the front of the application and to provide more information about what being a donor means. 4.Requires DMV to report annually for four years, plus provide quarterly updates, to Donate Life California and the appropriate policy and fiscal committees of the Legislature information on funds collected through the voluntary contributions as well as a summary of applicants, including non-identifiable information on gender, zip code, year of birth, and method of application (field office, online, or mail). 5.Authorizes the OPOs to create the Altruistic Living Donor SB 1395 (ALQUIST) Page 3 Registrar, which shall establish and maintain the Altruistic Living Donor Registry for persons who would like to identify themselves as kidney donors during their lifetimes. This registrar: Shall use information in the registry to expedite matches between donors and potential recipients. May receive voluntary contributions to support the registry and other activities. Shall collect and make available to the public information on the number of donors on the registry, changes in the numbers of donors, and general donor characteristics. May expand the registry to include living donors of organs and tissues other than kidneys if it can make a finding that these types of donations are generally safe, without significant risk of complications, and would not adversely affect the health of the donor. COMMENTS: 1.Purpose . Currently over 21,000 California residents are waiting for organ transplants. It is estimated that one-third of these people will die before they are able to receive the donations that they need. Of those, over 17,000 are waiting for a kidney transplant, and the waiting list continues to grow. This bill alters the process of applying for a new or renewal driver's license or identification card so that one must either enroll with the Donate Life California Organ and Tissue Donor Registry or decline to enroll. The author asserts that this change will increase the chances that a person will add him or herself to the registry. The bill further requires that DMV report annually with quarterly updates on the funds collected through voluntary contributions as well as a summary of information about applicants who consent to be organ donors. With this information, the organ donation community will know better the revenues it will receive and will be able to improve its donor-sign up outreach efforts. SB 1395 (ALQUIST) Page 4 2.Recent amendments . Recent amendments added Section 1 to this bill (described above in #5), which authorizes the creation of a registry for living donors. The subject matter of Section 1 of this bill is properly within in the jurisdiction of the Senate Health Committee and beyond the purview of this committee. This analysis, therefore, addresses primarily Section 2 of the bill relating to the existing donor sign up and funding program at DMV. Should this bill pass this committee, the motion should be to pass the bill and re-refer it to the Senate Rules Committee, so that it may then be re-referred to the Health Committee for consideration of the creation of a living donor registration and matching process. 3.Background . SB 108 (Speier), Chapter 740, Statutes of 2001 authorized the establishment of an Organ and Tissue Donor Registry in the California Health and Human Services Agency. The agency never received funding for the registry, and in 2003, SB 112 (Speier), Chapter 405, transferred responsibility for establishing the registry to a private, nonprofit organization administered by the four federally-designated OPOs. The four federally-designated OPOs are: California Transplant Donor Network, which serves 39 counties in northern and central California; Golden State Donor Services, which serves 11 counties in the Sacramento region; Lifesharing Community Organ & Tissue Donation, which serves San Diego and Imperial Counties; and OneLegacy, which serves counties in the Los Angeles area. SB 112 built on a provision of current law at that time that required DMV to provide donor registration forms to those applying for drivers' licenses or identification cards. These forms included instructions to mail the completed form to Donate Life California. Donate Life California found this system an ineffective method of signing up donors, and so in 2005 sponsored, SB 689 (Speier), Chapter 665, which requires DMV to collect organ and tissue donor designation information on its applications for drivers' licenses and identification cards. Donate Life reports that about 25 percent of those applying or renewing a driver's license or identification card sign up to be donors. This bill is a further attempt to increase that percentage. 1.Waiting at DMV . DMV reports that the wait times at its field SB 1395 (ALQUIST) Page 5 offices have increased dramatically over the past two years. Annual average wait times for those without appointments increased from 19 minutes 30 seconds in fiscal year 2007-08 to 41 minutes 20 seconds thus far in the current year. Average wait times in February and March of this year were over 55 minutes. For those with appointments the times are shorter, but the rate of increase is about the same with current wait time averaging about 15 minutes. This bill will exacerbate the trend of lengthening wait times in DMV offices. DMV currently processes about 3.75 million driver's license and identification card applications through its field offices each year. Under this bill, each of these nearly four million transactions would require a DMV clerk to confirm that the applicant has answered whether or not he or she will become an organ donor, and if the applicant has not answered, the clerk will have to explain to the applicant that he or she must answer and then wait while the applicant answers or asks further questions. This will result in perhaps a short increase in time spent at the DMV window for that applicant, but will further exacerbate the increasingly long wait times for all others awaiting service in DMV's offices. 2.Living donors and the driver's license . This bill provides for creation of the living donor registration system, and it also makes changes to the existing process for signing up organ and tissue donors through DMV. The bill, however, makes no connection between the two. That is, it does not conceive of using DMV to sign up living donors. POSITIONS: (Communicated to the Committee before noon on Wednesday, April 7, 2010) SUPPORT: California Hospital Association Donate Life California OPPOSED: None received.