BILL ANALYSIS Ó SENATE COMMITTEE ON HEALTH Senator Ed Hernandez, O.D., Chair BILL NO: SB 1419 --------------------------------------------------------------- |AUTHOR: |Galgiani | |---------------+-----------------------------------------------| |VERSION: |February 19, 2016 | --------------------------------------------------------------- --------------------------------------------------------------- |HEARING DATE: |April 6, 2016 | | | --------------------------------------------------------------- --------------------------------------------------------------- |CONSULTANT: |Reyes Diaz | --------------------------------------------------------------- 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 SB 1419 (Galgiani) Page 2 of ? 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 SB 1419 (Galgiani) Page 3 of ? 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 SB 1419 (Galgiani) Page 4 of ? 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 SB 1419 (Galgiani) Page 5 of ? capable of consenting to organ donation. SUPPORT AND OPPOSITION : Support: None received Oppose: None received -- END --