BILL ANALYSIS SB 1395 Page 1 Date of Hearing: June 28, 2010 ASSEMBLY COMMITTEE ON TRANSPORTATION Bonnie Lowenthal, Chair SB 1395 (Alquist) - As Amended: June 14, 2010 SENATE VOTE : 35-0 SUBJECT : Organ donation SUMMARY : Requires driver's license applicants to indicate whether or not they choose to be organ donors. Specifically, this bill : 1)Makes findings and declarations regarding the need for organ donors and the intent of the Legislature to establish an Altruistic Living Donor Registry (Altruistic Registry). 2)Authorizes California organ procurement organizations to establish a not-for-profit entity designated as the Altruistic Living Donor Registrar (Altruistic Registrar), which would establish and maintain an Altruistic Registry. 3)Requires the Altruistic Registry to contain information regarding persons who have identified themselves as altruistic living kidney donors and to be designed to promote and assist live kidney donations, including paired exchanges and nondirected donations. 4)Makes the Altruistic Registrar responsible for developing methods to increase the number of donors who enroll in the Altruistic Registry and requires him or her to make available to the federally designated organ procurement organizations and transplant centers in California information contained in the Registry regarding potential altruistic living donors. 5)Requires this information to be used to expedite a match between identified organ donors and potential recipients. 6)Allows the Altruistic Registrar to receive voluntary contributions to support the Altruistic Registry and its activities. 7)Requires the Altruistic Registrar to collect and make specified information relating to altruistic kidney donations SB 1395 Page 2 available to the public. 8)Allows the Altruistic Registrar to authorize the Altruistic Registry to include persons who identify themselves as altruistic living donors of organs and tissue other than kidneys to be added to the Registry, upon a finding by the Registrar that the donation is generally regarded as safe and without a significant risk of complications, and would not adversely affect the health of the donor. Upon making such a finding, the Registrar would be required to notify the appropriate policy committees of the Legislature. 9)Requires, on and after July 1, 2011, an application for a new or renewal driver's license or identification (ID) card to contain a space for the applicant to enroll in the Donate Life California Organ and Tissue Donor Registry (Donor Registry). 10) Requires the application to include check boxes for an applicant to mark either, "Yes, add my name to the donor registry," or "I do not wish to register at this time." 11) Requires the Department of Motor Vehicle (DMV) to inquire verbally of an applicant applying in person for an original or renewal driver's license or ID card at a DMV office as to whether the applicant wishes to enroll in the Donate Life California Organ and Tissue Donor Registry. Failure or refusal to answer this question or check a box on the application form would not constitute a basis for DMV to deny an applicant a driver's license or ID card. 12) Requires the driver's license and ID card applications to include the statement: "Marking 'Yes' adds your name to the Donate Life California Organ and Tissue Donor Registry and a pink 'donor' dot will appear on your license. If you wish to remove your name from the registry you must contact Donate Life California (see back); DMV can remove the pink dot from your licenses but cannot remove you from the registry." 13) Requires the backs of the applications to contain the statement: "If, on the front of this form, you marked 'Yes' to register as an organ and tissue donor you are legally authorizing the recovery of organs and tissues in the event of your death. Registering as a donor will not affect your medical treatment in any way. As outlined in the California Anatomical Gift Act, your authorization is legally binding and, unless the donor is under 18 years of age, your decision SB 1395 Page 3 does not require the consent of any other person. For registered donors under 18 years of age, the legal guardian shall make the final donation decision. You may limit your donation to organs or tissues, place usage restrictions, for example transplantation or research, obtain more information about donation, or remove your name from the registry on the Internet Web site of Donate Life California: www.donateLIFEcalifornia.org ." 14) Requires DMV to transmit to the Donor Registry and the appropriate policy and fiscal committees of the Legislature an annual report, and to make available quarterly updates, detailing funds collected through voluntary contributions as well as a summary of applicants, including date and method of application, donor registration status, zip code, gender, and year of birth. 15) Provides that the requirement for submitting the annual report is inoperative four years after the date the first annual report is due. EXISTING LAW : 1)Requires the front of an application for an original or renewal of a driver's license or ID card to contain a space for an applicant to give his or her consent to be an organ and tissue donor upon death. 2)Requires an applicant who gives consent to be directed to read a statement on the back of the application that contains specified information regarding organ donation. 3)Requires DMV to collect donor designation information on all applications for an original or renewal driver's license or ID card. 4)Requires DMV to print the word "DONOR" or another appropriate designation on the face of a driver's license or ID card to a person who registered as a donor. 5)Requires DMV, on a weekly basis, to electronically transmit to Donate Life California specified information on every applicant who has indicated his or her willingness to participate in the organ donation program. SB 1395 Page 4 6)Allows driver's license and ID card applicants to designate a voluntary contribution of $2 to Donate Life California to be collected by DMV for the purpose of promoting and supporting organ and tissue donation. 7)Requires the donor enrollment form to be posted on the Internet Web sites for DMV and the California Health and Human Services Agency. FISCAL EFFECT : Unknown. This bill was withdrawn from the Senate Appropriations Committee pursuant to Senate Rule 28.8. COMMENTS : 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's sponsor, Governor Arnold Schwarzenegger, states: "Organ donation is one of the kindest, most generous and powerful actions that each and every one of us can take. With thousands of people in California and throughout the nation currently waiting for a transplant, this legislation represents a new and important resource to increase donor rates. I am excited to partner with the legislature to implement this life-saving legislation and make California a leader in organ donations." A major portion of this bill deals with the establishment of an Altruistic Living Donor Registry to facilitate the donation of kidneys from living donors. These provisions have no transportation implications. The balance of the bill affects DMV in that it alters the process of applying for a new or renewal driver's license or ID card so that an applicant must either enroll with the Donor Registry or decline to enroll. If an applicant fails to check the Yes or No box, the DMV clerk would be required to prompt the applicant to indicate his or her choice. The author asserts that this change will increase the chances that a person will add him or herself to the Donor Registry. The bill further requires that DMV report annually, as well as provide 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 SB 1395 Page 5 information, the organ donation community will know better the revenues it will receive and will be able to improve its donor outreach efforts. SB 108 (Speier), Chapter 740, Statutes of 2001 authorized the establishment of a 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 organ procurement organizations. SB 112 (Speier), Chapter 405, Statutes of 2003, built on a provision of then-current law that required DMV to provide donor registration forms to those applying for drivers' licenses or ID 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 therefore sponsored SB 689 (Speier), Chapter 665, Statutes of 2005, which requires DMV to collect organ and tissue donor designation information on its applications for drivers' licenses and ID cards. Donate Life reports that about 25 percent of those applying or renewing a driver's license or ID card sign up to be donors. This bill is a further attempt to increase that percentage. Although DMV continues to struggle with wait times for its customers, it is unlikely that the added burden of requiring its clerks to pose to license applicant's follow-up questions on organ donations will have a significant impact on processing times and it may, in fact, ultimately result in saving additional lives. Author's amendment: Under this bill, the Altruistic Registrar would be authorized to allow the Altruistic Registry to expand to include individuals who designate themselves as altruistic living donors of organs and tissue other than kidneys if the Altruistic 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. The author agreed in the prior committee to amend the bill 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 registrar. The agreed-to amendment is as follows: On page 4, line 23, delete "registrar" and insert SB 1395 Page 6 "Centers for Medicare and Medicaid (CMS) and the United Network for Organ Sharing (UNOS)" REGISTERED SUPPORT / OPPOSITION : Support Governor Arnold Schwarzenegger (sponsor) American Federation of State, County and Municipal Employees 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 Stanford Hospital and Clinics Opposition None on file Analysis Prepared by : Howard Posner / TRANS. / (916) 319-2093