BILL ANALYSIS Ó
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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.
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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:
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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
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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,
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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,
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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
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