BILL ANALYSIS Ó ----------------------------------------------------------------- |SENATE RULES COMMITTEE | AB 1297| |Office of Senate Floor Analyses | | |1020 N Street, Suite 524 | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ----------------------------------------------------------------- THIRD READING Bill No: AB 1297 Author: John A. Pérez (D), et al. Amended: 8/19/13 in Senate Vote: 21 SENATE HEALTH COMMITTEE : 9-0, 6/12/13 AYES: Hernandez, Anderson, Beall, De León, DeSaulnier, Monning, Nielsen, Pavley, Wolk SENATE APPROPRIATIONS COMMITTEE : Senate Rule 28.8 ASSEMBLY FLOOR : 75-0, 5/9/13 (Consent) - See last page for vote SUBJECT : Coroners: organ donation SOURCE : Donate Life California DIGEST : This bill authorizes an organ procurement organization (OPO), when specified circumstances are present, to notify a coroner, prior to the donor's death, that a donor has made or may make an anatomical gift, and requires a coroner to accept that notification, whenever that notification will facilitate the coroner's ability to conduct his/her duties in a manner and within a period compatible with the preservation of the body or part for the purposes of the gift. This bill additionally requires the disclosure of medical information if the disclosure is compelled by a coroner upon notification of, or investigation of, imminent deaths that may involve organ or tissue donation. CONTINUED AB 1297 Page 2 Senate Floor Amendments of 8/19/13 make technical and non-substantive changes and add Senator Joel Anderson as a coauthor. ANALYSIS : Existing law: 1.Establishes the Uniform Anatomical Gift Act (UAGA) to govern organ and tissue donation in California and specifies who may make an anatomical 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.Requires a coroner or medical examiner (ME) to, assist in implementation of the UAGA; cooperate with OPOs to maximize the opportunity to recover anatomical gifts for the purpose of transplantation, therapy, research, or education; permit the authorized and lawful removal and timely disposition of donated organs and tissue from the bodies of deceased persons; ensure anatomical gifts do not interfere with an autopsy or investigation; and enter into agreements with OPOs to coordinate gift recovery procedures within that coroner's or ME's jurisdiction or in cooperation with other coroners or MEs throughout the state. 3.Establishes the Confidentiality of Medical Information Act (Act), which prohibits a health care provider, a contractor, or a health care service plan from disclosing medical information, as defined, regarding a patient of the provider or an enrollee or subscriber of the health care service plan without first obtaining an authorization, except as specified. 4.Requires the disclosure of medical information if the disclosure is compelled by a coroner when investigating deaths that may involve organ or tissue donation. 5.Makes a violation of the Act that results in economic loss or personal injury to a patient, a misdemeanor. This bill: CONTINUED AB 1297 Page 3 1.Authorizes a provider of health care, health care service plan, or contractor to disclose medical information regarding a patient or prospective donor, when requested in the course of an investigation by the coroner's office upon notification of, or investigation of, imminent deaths that may involve organ or tissue donation, or when otherwise authorized by the decedent's representative. 2.Clarifies that if a county coroner receives notice from an OPO that an anatomical gift might be available with respect to a decedent whose body is under the jurisdiction of the coroner and a post-mortem examination or investigation is going to be performed, unless the coroner denies recovery, the coroner is required to conduct a post-mortem examination or investigation of the body in a manner and within a period compatible with its preservation for the purposes of the gift. 3.Clarifies that notwithstanding any other law, when an anatomical gift might be available or has been made by a person whose death is imminent due to the lawful withdrawal of medical treatment and if that person's body, post-mortem, will be subject to the coroner's jurisdiction, an OPO is permitted to notify a coroner of the anatomical gift, and requires a coroner to accept the notification, whenever that notification will facilitate the coroner's ability to conduct a post-mortem examination or investigation of the body in a manner and within a period compatible with its preservation for the purposes of the gift. Comments Organ Donation Process . According to Donate Life California (DLC), most organ donors are accident victims who have suffered severe and eventually fatal injuries - often a severe head injury. After arriving at the scene of such an accident, emergency medical personnel immediately begin life-saving procedures while the patient is transported to a hospital where every effort is made to save the patient's life. Once a patient is determined brain dead by two different doctors, the hospital must refer the patient to the local OPO. An OPO is a non-profit organization that is responsible for the evaluation and procurement of deceased-donor organs for organ transplantation. The individual OPOs represent the front-line CONTINUED AB 1297 Page 4 of organ procurement. There are currently four OPOs that have been designated in California (California Transplant Donor Network, Golden State Donor Services, LifeSharing, and OneLegacy). The OPO conducts an evaluation to determine if organ donation is an option. If the patient is eligible to donate, the OPO will speak to the family. Once consent is granted, the OPO works with the DLC Registry to identify the best candidates for the available organs and coordinates with the surgical team for each organ recipient. Coroner/ME's Role . A county coroner/ME plays an important role in the organ and tissue donation process. Since all unexpected deaths require coroner/ME review, their cooperation and support is vital for ensuring successful organ and tissue donations to benefit thousands of transplant recipients each year. OPOs collaborate with coroners/MEs in the referral and evaluation of potential organ and tissue donors to broaden the donation options for donor families, while preserving evidence for death investigations to determine the cause and manner of death. OPOs usually have a coroner liaison to serve as a dedicated resource regarding donation, and who works closely with coroners and MEs. After the OPO staff determines organ and tissue recovery will take place, the coroner/ME is notified and clearance is obtained for transplantation to occur in accordance with UAGA. Currently, consultation between coroners/MEs and OPOs takes place after a potential donor has died. However, in cases where OPOs communicate information to coroners/MEs about the gift wishes of a donor who is on life support prior to death, coroners/MEs are prevented from doing anything more than taking the information. This bill seeks to formalize the communication between coroners/MEs and OPOs in cases where a person who wishes to donate is facing imminent death and his/her body after death will be subject to a death investigation by the coroner/ME, such as a person who has been taken off life support, in order to facilitate timely recovery of the donated organs. Prior Legislation SB 1395 (Alquist, Chapter 217, Statutes of 2010) authorized establishment of an Altruistic Living Donor Registry to promote and assist live kidney donations and required, by July 1, 2011, CONTINUED AB 1297 Page 5 an applicant for an initial or renewal driver's license or identification card to designate whether or not he/she wishes to become an organ and tissue donor. AB 1689 (Lieber, Chapter 629, Statutes of 2007) revised UAGA, which regulates anatomical gifts and the disposition of donated bodies and body parts. AB 777 (Dutton, Chapter 309, Statutes of 2003) provided procedures for removal of organs for transplant when requested by an OPO in the case of an anatomical gift from a decedent whose death requires an inquest by the coroner/ME. FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes Local: Yes SUPPORT : (Verified 8/20/13) Donate Life California (source) California State Coroners' Association ARGUMENTS IN SUPPORT : Donate Life California (DLC), the sponsors of this legislation, and the California State Coroner's Association (CSCA) write in support that this bill recognizes and clarifies in UAGA the relationship between OPOs and the coroners in what is known as "imminent" coroner jurisdiction cases. These cases relate to those individuals who have expressed their intent to donate, but who do not technically fall under the coroner's jurisdiction quite yet. DLC and CSCA state what makes these cases unique is that there is a very narrow time window between declaration of death and the commencement of organ recovery by the OPOs. These circumstances require the OPO to consult with the coroner prior to declaration of death in cases where the body is deemed likely to fall under the coroner's jurisdiction post mortem. DLC and CSCA maintain this bill will make uniform a practice that is currently occurring to ensure all interested parties are able to perform their responsibilities and honor the donor's wish to save lives. ASSEMBLY FLOOR : 75-0, 5/9/13 AYES: Achadjian, Alejo, Allen, Ammiano, Atkins, Bigelow, Bloom, Blumenfield, Bocanegra, Bonilla, Bonta, Bradford, Brown, Buchanan, Ian Calderon, Campos, Chau, Chávez, Chesbro, Conway, CONTINUED AB 1297 Page 6 Cooley, Dahle, Daly, Dickinson, Eggman, Fong, Fox, Frazier, Beth Gaines, Garcia, Gatto, Gomez, Gordon, Gorell, Gray, Grove, Hagman, Hall, Harkey, Roger Hernández, Jones, Jones-Sawyer, Levine, Linder, Lowenthal, Maienschein, Mansoor, Medina, Melendez, Mitchell, Morrell, Mullin, Muratsuchi, Nazarian, Nestande, Olsen, Pan, Patterson, Perea, V. Manuel Pérez, Quirk, Quirk-Silva, Rendon, Salas, Skinner, Stone, Ting, Torres, Wagner, Weber, Wieckowski, Wilk, Williams, Yamada, John A. Pérez NO VOTE RECORDED: Donnelly, Holden, Logue, Waldron, Vacancy JL:ej 8/20/13 Senate Floor Analyses SUPPORT/OPPOSITION: SEE ABOVE **** END **** CONTINUED