BILL ANALYSIS                                                                                                                                                                                                    



          SENATE COMMITTEE ON HEALTH
                          Senator Ed Hernandez, O.D., Chair

          BILL NO:                    SB 1419             
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          |AUTHOR:        |Galgiani                                       |
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          |VERSION:       |February 19, 2016                              |
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          |HEARING DATE:  |April 6, 2016  |               |               |
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          |CONSULTANT:    |Reyes Diaz                                     |
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           SUBJECT  :  Uniform Anatomical Gift Act: prison inmates

           SUMMARY  : Requires the Department of Corrections and Rehabilitation  
          (CDCR) to develop a form, as specified, allowing a prisoner to  
          elect to make an anatomical gift in the event of his or her  
          death. Requires CDCR to present the form to the prisoner, as  
          specified, as well as to allow the prisoner to revoke his or her  
          election to make an anatomical gift, as specified. 
          
          Existing law: Establishes the Uniform Anatomical Gift Act, which  
          regulates the making and distribution of organ donations.
            
          This bill:
          1)Requires CDCR to develop and adopt a form that allows a  
            prisoner to elect to make an anatomical gift in the event of  
            his or her death. Requires the form to be included in the  
            prisoner's central file.

          2)Requires the form to be titled "Document of Gift-Donate Life  
            California Organ and Tissue Donor Registry" and to have at a  
            minimum the following characteristics:

                  a)        Clearly indicate the prisoner's election to be  
                    added to the donor registry;
                  b)        Contain a statement notifying the prisoner  
                    that by signing or placing his or her mark on the form  
                    that the prisoner is legally authorizing the recovery  
                    of organs or tissues in the event of his or her death;  
                    and, 
                  c)        Contains the prisoner's signature or mark if  
                    the prisoner cannot write.

          3)Requires the form to be presented to the prisoner upon his or  







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            her first admittance into the state prison system. Allows the  
            prisoner to elect to sign the form or refuse to sign at that  
            time.

          4)Requires the form to be made available for completion and  
            signature at the prisoner's request, consistent with the  
            policies and procedures of CDCR. 

          5)Allows the prisoner to revoke his or her election to make an  
            anatomical gift at any time by delivery of a written statement  
            to the official in charge of the facility where the prisoner  
            is confined. Requires CDCR, upon receipt of this statement, to  
            mark the form described in 2) above as revoked. Requires CDCR  
            to retain the revoked document of gift and the statement  
            revoking the gift in the prisoner's central file.

           FISCAL  
          EFFECT  : This bill has not been analyzed by a fiscal committee.
           
          COMMENTS  :
          1)Author's statement. According to the author, the United States  
            is currently facing a shortage of anatomical gift donors, with  
            California making up 20% of the national donor waiting list.  
            Additionally, less than one percent of hospital deaths meet  
            the criteria for organ donation. It is estimated that one  
            individual organ donor can save the lives of up to eight  
            people, and tissue donors can help more than 50 people. Due to  
            the fact that there is no process in place to provide inmates  
            with the chance to donate, potential donors are prevented from  
            registering. This bill will create a voluntary process for an  
            inmate to register as an organ donor, which could increase the  
            donor pool. It is important to note that this bill also  
            requires a process to be in place for the inmate to remove  
            him- or herself from registration at any time. In Utah, where  
            similar legislation allowing for voluntary sign up has been  
            enacted, more than 250 inmates have already signed up to be  
            donors.

          2)Background. The Organ Procurement and Transplantation Network  
            (OPTN) is a public-private partnership that links all  
            professionals involved in the United States donation and  
            transplantation system. The United Network for Organ Sharing  
            (UNOS) serves as the OPTN under contract with the Health  
            Resources and Services Administration of the U.S. Department  
            of Health and Human Services. Currently, every transplant  








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            hospital program and organ procurement organization in the  
            U.S. is an OPTN member. Membership means that their transplant  
            programs are certified by UNOS and that they play an active  
            role in forming the policies that govern the transplant  
            community. In California, there are 21 transplant centers  
            (hospitals) and four organ procurement organizations (OPOs),  
            which are authorized by the Centers for Medicare and Medicaid  
            Services to procure organs for transplantation. Each  
            individual hospital comes up with their own policies to  
            evaluate patients and determine eligibility to receive an  
            organ transplant. UNOS develops the policies to determine how  
            available organs are distributed among eligible patients  
            waiting for a transplant. According to Donate Life  
            California's Web site, there are currently more than 123,000  
            people in the U.S. waiting for a life-saving organ transplant,  
            and nearly 22,000 live in California. Every 10 minutes another  
            person is added to the waiting list. 

          3)CDCR inmate screening. According to CDCR, inmates are screened  
            at intake by a nurse to identify any physical and mental  
            health care needs. The inmate is tested for tuberculosis and  
            hepatitis C, and, if requested, for HIV. Within 14 days of  
            entering CDCR's custody, all inmates undergo a comprehensive  
            medical evaluation in which a physician obtains a medical  
            history from the inmate. Any information obtained during the  
            medical evaluation is self-disclosed by the inmate, as CDCR  
            does not have access to any prior medical records. Any process  
            involving informed consent is required to be done by a  
            physician during the comprehensive medical evaluation. CDCR  
            does not solicit an inmate's interest in being an organ and  
            tissue donor. Inmates are responsible for disclosing whether  
            they are already registered as organ and tissue donors during  
            the medical evaluation, and that information is noted in the  
            medical record.

          CDCR provides an Advance Directive for Health Care to an inmate  
            if it is requested specifically by the inmate or the inmate's  
            medical condition warrants it because the inmate is facing a  
            life-threatening condition or treatment. This document  
            consists of a durable power of attorney, which allows inmates  
            to designate someone to make decisions on their behalf if they  
            are unable to do it on their own, and a living will, which  
            allows inmates to state their goals or desires for the types  
            of health care they do or do not want. The advance directive  
            form includes an optional section for an inmate to choose  








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            whether or not he or she is willing to donate organs or other  
            tissues upon death. If an inmate chooses to complete this part  
            of the form, the inmate is instructed to check the box that  
            applies to the inmate's wish. The inmate may give any needed  
            organs or tissues, may specify which organs and tissues he or  
            she wants to donate, or may select the box choosing not to  
            donate. The inmate may also designate whether his or her gift  
            is for purposes of transplantation, therapy, research, or  
            education. Before an inmate signs the advance directive, a  
            medical staff person is required to document that the inmate  
            has been fully informed and understands the form, and two  
            additional witnesses are required to verify that the inmate  
            has willingly signed the form and completed it according to  
            the inmate's wishes.   

          4)Double referral. Should this bill pass out of this Committee,  
            it will be referred to the Senate Committee on Public Safety.

          5)Prior legislation. SB 1395 (Alquist, Chapter 217, Statutes of  
            2010), authorized the establishment of a living donor registry  
            to sign up kidney donors and required the Department of Motor  
            Vehicles to include on an application for an original or  
            renewal driver's license or identification card specified  
            language asking the applicant if he or she wants to enroll  
            with the Donate Life California Organ and Tissue Donor  
            Registry and giving the applicant information about the  
            registry, including disenrollment information.

            AB 2440 (Berryhill, of 2010), would have required prison  
            inmates to complete an organ and tissue donor consent form  
            upon admittance to a state prison. AB 2440 failed passage in  
            the Assembly Health Committee.

            AB 289 (Plescia, of 2003), would have, among other things,  
            allowed an organ donor to prohibit his or her organs from  
            being donated to prison inmates. AB 289 was never heard in the  
            Assembly Health Committee.

          6)Policy comment. This bill requires the organ donation form to  
            be presented to a prisoner upon first admittance. While CDCR  
            states that at intake prisoners are screened for physical and  
            mental health care needs, it is unclear whether the screening  
            would occur before or after the organ donation form is  
            presented to the inmate. This raises the question of whether a  
            prisoner who is determined to need mental health care needs is  








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            capable of consenting to organ donation. 
          
           SUPPORT AND OPPOSITION  :
          Support:  None received
          
          Oppose:   None received
          

          
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