BILL ANALYSIS
SB 1395
Page 1
Date of Hearing: June 22, 2010
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
SB 1395 (Alquist) - As Amended: June 14, 2010
SENATE VOTE : 35-0
SUBJECT : Organ donation.
SUMMARY : Authorizes establishment of an Altruistic Living Donor
Registry to promote and assist live kidney donations and
requires, by July 1, 2011, an applicant for an initial or
renewal driver's license or identification card to designate
whether or not he or she wishes to become an organ and tissue
donor. Specifically, this bill :
1)Authorizes the state's federally-designated organ procurement
organizations (OPOs) to establish a not-for-profit Altruistic
Living Donor Registrar (registrar) to establish and maintain a
living donor registry designed to promote and assist live
kidney donations, including donor chains, paired exchanges,
and nondirected donations.
2)Makes the registrar responsible for developing methods to
increase the number of donors who enroll in the registry and
requires the information contained in the registry to be made
available to OPOs and transplant centers in California and
used to expedite a match between identified organ donors and
potential recipients.
3)Allows the registrar to receive voluntary contributions to
support the registry and its activities and requires the
registrar to collect and make specified information relating
to altruistic kidney donations available to the public.
4)Permits the registrar to allow persons who identify themselves
as altruistic living donors of organs and tissue other than
kidneys to be added to the registry if the 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; and, requires the appropriate
policy committees of the Legislature to be notified if the
registry is expanded in this manner.
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5)Requires, on and after July 1, 2011, the application for an
initial or renewal driver's license to contain yes or no check
boxes for the purpose of allowing an applicant to add his or
her name to the existing Donate Life California Organ and
Tissue Donor Registry.
6)Directs the Department of Motor Vehicles (DMV) to inquire
verbally of an applicant applying in person for an original or
renewal driver's license or identification card at a
department office as to whether the applicant wishes to enroll
in the organ donor registry, and prohibits failure or refusal
to answer this question or check a box on the application form
from being a basis for DMV to deny an applicant a driver's
license or identification card.
7)Requires information relating to disenrolling from the
registry to be disclosed with the check boxes required by 6)
above and makes clarifying changes to information regarding
medical treatment that DMV is already required to provide on
the back of the application form.
8)Directs DMV to provide annual reports and submit quarterly
updates for four years, to the Donate Life California Registry
and the Legislature, information on funds collected through
voluntary contributions as well as a summary of applicants
that includes specified non-identifiable information.
9)Makes a number of findings and declarations relating to the
life-saving importance of organ donation and transplantation.
EXISTING LAW :
1)Establishes the Uniform Anatomical Gift Act (UAGA) which
governs organ and tissue donation in California. Includes
provisions relating to the donation process, including who may
make a 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)Authorizes the state's OPOs to designate Donate Life
California as the registrar of the California Organ and Tissue
Donor Registry.
3)Permits individuals who renew or apply for a driver's license
or identification card with the DMV to register as an organ
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and tissue donor, and provides for the pink "donor" dot symbol
to be pre-printed on the applicant's driver's license or
identification card.
4)Allows an applicant for a driver's license or identification
card to designate a voluntary contribution of $2 to support
organ and tissue donation. Directs DMV to collect these
contributions, deduct a portion for the administrative costs
associated with signing up donors, and then transmit the
remainder to Donate Life California.
FISCAL EFFECT : According to the Senate Appropriations
Committee, pursuant to Senate Rule 28.8, negligible state costs.
COMMENTS :
1)PURPOSE OF THIS BILL . The author states that this bill seeks
to create the first altruistic living donor registry in the
country that would be composed of individuals who are willing
to donate a kidney to help others. The author notes that
kidneys can be donated by a living donor through a fairly
simple medical procedure and the registry established in this
bill will expedite the match between organ donors and
recipients. The author states that there is a great need for
this registry as more than 17,000 Californians are waiting for
a kidney transplant and the waiting list continues to grow.
The author points out that the living donor registry created
by this bill is designed to increase the number of potential
kidney donors, thereby helping to reduce the largest component
of the long recipient waiting list. According to the author,
only 27% of DMV customers check yes to designate themselves as
organ donors and while that level is an improvement from 20%
four years ago, the state needs to do better recruiting
donors . The author argues that adding a "no" box, as simple
as it seems, to the existing application for an original or
renewal driver's license or identification card will improve
the donor designation rate by allowing DMV to ask customers to
answer the donation question.
2)ORGAN AND TISSUE DONATION . Currently more than 100,000 people
in the U.S. are waiting for organ transplants, and 21,000 of
them are California residents. In California, minorities
represent 64% of organ transplant candidates and 71% of those
waiting for kidneys. Each year, more than 6,000 people die
waiting for an organ transplant that would have given them a
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second chance at life with their families while hundreds of
thousands of people benefit from donated tissue that is used
for life-saving and reconstructive purposes. The most
commonly transplanted organs are kidneys, liver, heart, and
lungs. Tissues commonly used in transplantation include skin,
bone, heart valves, tendons, veins, and corneas. Many tissues
that cannot be used for transplant can still be recovered and
used in various research studies to advance medical science.
3)CURRENT REGISTRY . SB 108 (Speier), Chapter 740, Statutes of
2001, authorizes the establishment of the registry in the
California Health and Human Services Agency (CHHSA). Since
CHHSA never received funds for the registry, SB 112 (Speier),
Chapter 405, Statutes of 2003, transferred responsibility for
establishing the registry to a private, nonprofit organization
administered by the four federally-designated OPOs: California
Transplant Donor Network, in northern and central California;
Golden State Donor Services, in the Sacramento region;
Lifesharing Community Organ & Tissue Donation, in San Diego
and Imperial Counties; and, OneLegacy, in the Los Angeles
area. Donate Life California was formed in 2004 to manage the
registry, which allows Californians who are at least 18 years
of age to register their authorization to donate specific or
all organs or tissue upon death. Children between the ages of
13 and 17 can join the registry, but a minor's parent or legal
guardian is allowed to make the final decision about organ and
tissue donation at the appropriate time. The registry allows
individuals to sign up as donors online. According to Donate
Life California, there are over a million individuals who have
signed up in the registry.
4)SUPPORT . According to the sponsor, Governor Schwarzenegger,
this bill will make California a leader in organ donation by
requiring driver's license applicants to either affirmatively
register to be an organ donor or allow the choice to be made
at another time and creating the first in the nation live
donor registry aimed at increasing kidney donations. Donate
Life California states that this bill will make an altruistic
living donor registry operational in California for those
persons who wish to help others as a living kidney donor but
do not have family or close friends to whom they can donate.
Stanford Hospitals and Clinics writes in support that its
patients have benefited from kidney donor chains initiated by
altruistic non-directed donors and recommends that this bill
include provisions to allow the transplant community
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flexibility to address the logistical and ethical issues that
will arise. The National Kidney Foundation notes that
expanding both the number of Californians registering their
consent to become organ donors after death, as well as the
number of transplants made possible through kidney donations
by living donors, is critical to solving the current organ
shortage in the state. Supporters add that this bill will
provide new ways for individuals to learn about organ donation
and decide to generously and selflessly sign up to be donors,
which, in turn, will help facilitate matches between donors
and recipients.
5)PRIOR LEGISLATION .
a) AB 1689 (Lieber), Chapter 629, Statutes of 2007, revises
UAGA, which regulates anatomical gifts and the disposition
of donated bodies and body parts.
b) SB 689 (Speier), Chapter 665, Statutes of 2005, requires
DMV to collect organ and tissue donor designation
information on its applications for drivers' licenses and
identification cards, and links DMV with the state's
existing donor and tissue registry.
c) SB 112 transfers responsibility for establishing the
registry to a private, nonprofit organization administered
by the four OPOs.
d) SB 108 authorizes the establishment of the registry in
the CHHSA.
6)DOUBLE REFERRAL . This bill has been double referred. Should
this bill pass this committee, it will be referred to the
Assembly Transportation Committee.
7)SUGGESTED AMENDMENT . Under this bill, the registrar would be
authorized to allow the registry to expand to include
individuals who designate themselves as altruistic living
donors of organs and tissue other than kidneys if the
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. This bill should be
amended 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
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registrar.
On page 4, line 23, delete "registrar" and insert " Centers for
Medicare and Medicaid (CMS) and the United Network for Organ
Sharing (UNOS) "
Due to legislative deadlines, the author has agreed to take
this amendment in the Assembly Transportation Committee.
REGISTERED SUPPORT / OPPOSITION :
Support
Governor Arnold Schwarzenegger (sponsor)
American Federation of State, County and Municipal Employees,
AFL-CIO
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 Board of Supervisors
Stanford Hospital and Clinics
Opposition
None on file.
Analysis Prepared by : Cassie Rafanan / HEALTH / (916)
319-2097