BILL ANALYSIS SB 1395 Page 1 Date of Hearing: June 22, 2010 ASSEMBLY COMMITTEE ON HEALTH William W. Monning, Chair SB 1395 (Alquist) - As Amended: June 14, 2010 SENATE VOTE : 35-0 SUBJECT : Organ donation. SUMMARY : Authorizes establishment of an Altruistic Living Donor Registry to promote and assist live kidney donations and requires, by July 1, 2011, an applicant for an initial or renewal driver's license or identification card to designate whether or not he or she wishes to become an organ and tissue donor. Specifically, this bill : 1)Authorizes the state's federally-designated organ procurement organizations (OPOs) to establish a not-for-profit Altruistic Living Donor Registrar (registrar) to establish and maintain a living donor registry designed to promote and assist live kidney donations, including donor chains, paired exchanges, and nondirected donations. 2)Makes the registrar responsible for developing methods to increase the number of donors who enroll in the registry and requires the information contained in the registry to be made available to OPOs and transplant centers in California and used to expedite a match between identified organ donors and potential recipients. 3)Allows the registrar to receive voluntary contributions to support the registry and its activities and requires the registrar to collect and make specified information relating to altruistic kidney donations available to the public. 4)Permits the registrar to allow persons who identify themselves as altruistic living donors of organs and tissue other than kidneys to be added to the registry if the registrar finds that these types of donations are generally safe, without significant risk of complications, and would not adversely affect the health of the donor; and, requires the appropriate policy committees of the Legislature to be notified if the registry is expanded in this manner. SB 1395 Page 2 5)Requires, on and after July 1, 2011, the application for an initial or renewal driver's license to contain yes or no check boxes for the purpose of allowing an applicant to add his or her name to the existing Donate Life California Organ and Tissue Donor Registry. 6)Directs the Department of Motor Vehicles (DMV) to inquire verbally of an applicant applying in person for an original or renewal driver's license or identification card at a department office as to whether the applicant wishes to enroll in the organ donor registry, and prohibits failure or refusal to answer this question or check a box on the application form from being a basis for DMV to deny an applicant a driver's license or identification card. 7)Requires information relating to disenrolling from the registry to be disclosed with the check boxes required by 6) above and makes clarifying changes to information regarding medical treatment that DMV is already required to provide on the back of the application form. 8)Directs DMV to provide annual reports and submit quarterly updates for four years, to the Donate Life California Registry and the Legislature, information on funds collected through voluntary contributions as well as a summary of applicants that includes specified non-identifiable information. 9)Makes a number of findings and declarations relating to the life-saving importance of organ donation and transplantation. EXISTING LAW : 1)Establishes the Uniform Anatomical Gift Act (UAGA) which governs organ and tissue donation in California. Includes provisions relating to the donation process, including who may make a gift, how to document a gift or refusal, how to amend or revoke a gift, to whom a gift may be made, and delivery of a gift. 2)Authorizes the state's OPOs to designate Donate Life California as the registrar of the California Organ and Tissue Donor Registry. 3)Permits individuals who renew or apply for a driver's license or identification card with the DMV to register as an organ SB 1395 Page 3 and tissue donor, and provides for the pink "donor" dot symbol to be pre-printed on the applicant's driver's license or identification card. 4)Allows an applicant for a driver's license or identification card to designate a voluntary contribution of $2 to support organ and tissue donation. Directs DMV to collect these contributions, deduct a portion for the administrative costs associated with signing up donors, and then transmit the remainder to Donate Life California. FISCAL EFFECT : According to the Senate Appropriations Committee, pursuant to Senate Rule 28.8, negligible state costs. COMMENTS : 1)PURPOSE OF THIS BILL . The author states that this bill seeks to create the first altruistic living donor registry in the country that would be composed of individuals who are willing to donate a kidney to help others. The author notes that kidneys can be donated by a living donor through a fairly simple medical procedure and the registry established in this bill will expedite the match between organ donors and recipients. The author states that there is a great need for this registry as more than 17,000 Californians are waiting for a kidney transplant and the waiting list continues to grow. The author points out that the living donor registry created by this bill is designed to increase the number of potential kidney donors, thereby helping to reduce the largest component of the long recipient waiting list. According to the author, only 27% of DMV customers check yes to designate themselves as organ donors and while that level is an improvement from 20% four years ago, the state needs to do better recruiting donors . The author argues that adding a "no" box, as simple as it seems, to the existing application for an original or renewal driver's license or identification card will improve the donor designation rate by allowing DMV to ask customers to answer the donation question. 2)ORGAN AND TISSUE DONATION . Currently more than 100,000 people in the U.S. are waiting for organ transplants, and 21,000 of them are California residents. In California, minorities represent 64% of organ transplant candidates and 71% of those waiting for kidneys. Each year, more than 6,000 people die waiting for an organ transplant that would have given them a SB 1395 Page 4 second chance at life with their families while hundreds of thousands of people benefit from donated tissue that is used for life-saving and reconstructive purposes. The most commonly transplanted organs are kidneys, liver, heart, and lungs. Tissues commonly used in transplantation include skin, bone, heart valves, tendons, veins, and corneas. Many tissues that cannot be used for transplant can still be recovered and used in various research studies to advance medical science. 3)CURRENT REGISTRY . SB 108 (Speier), Chapter 740, Statutes of 2001, authorizes the establishment of the registry in the California Health and Human Services Agency (CHHSA). Since CHHSA never received funds for the registry, SB 112 (Speier), Chapter 405, Statutes of 2003, transferred responsibility for establishing the registry to a private, nonprofit organization administered by the four federally-designated OPOs: California Transplant Donor Network, in northern and central California; Golden State Donor Services, in the Sacramento region; Lifesharing Community Organ & Tissue Donation, in San Diego and Imperial Counties; and, OneLegacy, in the Los Angeles area. Donate Life California was formed in 2004 to manage the registry, which allows Californians who are at least 18 years of age to register their authorization to donate specific or all organs or tissue upon death. Children between the ages of 13 and 17 can join the registry, but a minor's parent or legal guardian is allowed to make the final decision about organ and tissue donation at the appropriate time. The registry allows individuals to sign up as donors online. According to Donate Life California, there are over a million individuals who have signed up in the registry. 4)SUPPORT . According to the sponsor, Governor Schwarzenegger, this bill will make California a leader in organ donation by requiring driver's license applicants to either affirmatively register to be an organ donor or allow the choice to be made at another time and creating the first in the nation live donor registry aimed at increasing kidney donations. Donate Life California states that this bill will make an altruistic living donor registry operational in California for those persons who wish to help others as a living kidney donor but do not have family or close friends to whom they can donate. Stanford Hospitals and Clinics writes in support that its patients have benefited from kidney donor chains initiated by altruistic non-directed donors and recommends that this bill include provisions to allow the transplant community SB 1395 Page 5 flexibility to address the logistical and ethical issues that will arise. The National Kidney Foundation notes that expanding both the number of Californians registering their consent to become organ donors after death, as well as the number of transplants made possible through kidney donations by living donors, is critical to solving the current organ shortage in the state. Supporters add that this bill will provide new ways for individuals to learn about organ donation and decide to generously and selflessly sign up to be donors, which, in turn, will help facilitate matches between donors and recipients. 5)PRIOR LEGISLATION . a) AB 1689 (Lieber), Chapter 629, Statutes of 2007, revises UAGA, which regulates anatomical gifts and the disposition of donated bodies and body parts. b) SB 689 (Speier), Chapter 665, Statutes of 2005, requires DMV to collect organ and tissue donor designation information on its applications for drivers' licenses and identification cards, and links DMV with the state's existing donor and tissue registry. c) SB 112 transfers responsibility for establishing the registry to a private, nonprofit organization administered by the four OPOs. d) SB 108 authorizes the establishment of the registry in the CHHSA. 6)DOUBLE REFERRAL . This bill has been double referred. Should this bill pass this committee, it will be referred to the Assembly Transportation Committee. 7)SUGGESTED AMENDMENT . Under this bill, the registrar would be authorized to allow the registry to expand to include individuals who designate themselves as altruistic living donors of organs and tissue other than kidneys if the registrar finds that these types of donations are generally safe, without significant risk of complications, and would not adversely affect the health of the donor. This bill should be amended to require such a determination to be made upon a finding by the federal Centers for Medicare and Medicaid and the United Network for Organ Sharing, rather than the SB 1395 Page 6 registrar. On page 4, line 23, delete "registrar" and insert " Centers for Medicare and Medicaid (CMS) and the United Network for Organ Sharing (UNOS) " Due to legislative deadlines, the author has agreed to take this amendment in the Assembly Transportation Committee. REGISTERED SUPPORT / OPPOSITION : Support Governor Arnold Schwarzenegger (sponsor) American Federation of State, County and Municipal Employees, AFL-CIO California Academy of Physician Assistants California Hospital Association California Medical Association Community Health Partnership DaVita Dialysis Donate Life California El Camino Hospital National Kidney Foundation Santa Clara County Board of Supervisors Stanford Hospital and Clinics Opposition None on file. Analysis Prepared by : Cassie Rafanan / HEALTH / (916) 319-2097