Legislature(1993 - 1994)
02/18/1994 01:15 PM House JUD
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
Number 034
CHAIRMAN PORTER announced the committee would take up HB
323.
HB 323 - RELEASE OF CERTAIN DEATH CERTIFICATE INFORMATION
CSHB 323(JUD) am: "An Act relating to requests for
anatomical gifts and to the release of certain information
for the purpose of facilitating anatomical gifts."
Number 049
REP. CYNTHIA TOOHEY, Prime Sponsor of HB 323, referred to
the committee substitute (CS) and explained it changed one
word on page 1, line 13, deleting "statistics" and adding
"records." She gave the following statement to the
committee:
"Thank you for the opportunity to discuss HB 323. For
purposes of presentation and discussion, I would ask that
the committee adopt the CS which all members have in their
file.
"This bill would help facilitate organ and tissue donation.
Over 300 tissue and organ transplants are anticipated this
year. This includes tendon, bone, tissue, corneal, heart
valve, and bone transplants. For the families who have
donated the tissue or organs of their loved one, this can
provide great consolation for that family to know one or
several individuals have had quality of life improve because
of the donation.
"Currently, statute restricts the release of information
from death certificates in the Bureau of Vital Statistics.
In the case of organ and tissue donations, this may mean
that potential donors are lost due to delay, since time is
of the essence in harvesting the tissue.
"HB 323 would enable a bank, storage facility, or person who
handles procurement of anatomical gifts to obtain the
necessary information from the Department of Health and
Social Services (DHSS) within a time frame allowing for
successful donation.
"The information would be contained:
1. On the certificate
2. Collected by the Department for completing the
certificate or,
3. In information from other vital human records.
(The supplemental coroner's report is an example.)
"To assure the most expedient process, obtaining this
information from the medical examiner or the bureau prior to
its officially appearing on the death certificate
necessitates the broader definition. When a death occurs,
the medical
examiner is one of the first to know. The pertinent
information would consist of:
1. The name of the person who could execute the
anatomical gift.
2. The medical suitability of the potential donation.
"In other words, this information would allow the person
potentially procuring the donation to know:
1. If the tissue or organ was healthy.
2. Who to contact to obtain permission in a timely
manner to allow successful harvesting.
"The DHSS and the court system are strongly supportive of
this legislation. It has two zero fiscal notes. The
proposed CS is technical in nature and consists of changing
one word. I believe the committee received an information
sheet regarding the change, but I would be happy to address
the proposed change if the committee wishes."
REP. TOOHEY stated that JENS SAAKVITNE from Life, Alaska
(via teleconference), DR. NAKAMURA from DHSS, and CHRIS
CHRISTENSEN from the court system were there to respond to
questions, too.
Number 151
JENS SAAKVITNE, Director, Life Alaska, which is an Alaska
based nonprofit tissue bank serving Alaska, testified in
favor of HB 323. Mr. Saakvitne indicated that in 1993
Alaska had 87 tissue donors and they supplied a little over
200 tissue transplants to the state along with approximately
800 out-of-state, and some of the transplants included 40
corneal transplants, 150 tendons, a heart valve and a lower
leg bone for transplant, along with knee and shoulder
repair. Mr. Saakvitne said that of the decedents family
Life Alaska has talked to and presented the option of
donation, between 75 and (inaudible) agreed to donation, and
those that agree to donation enter into a two year
bereavement support group. He concluded that Life Alaska
would make every opportunity to serve the community of
Alaska, both as far as recipient needs and giving whatever
support they can to the decedent's family.
Number 208
JACK PHELPS, Legislative Aide, Rep. Pete Kott, testified on
behalf of himself in opposition to certain portions of HB
323. Mr. Phelps indicated he was not testifying against the
concept of organ donations; however, he shared with the
committee his qualifications for why he wants to speak on
another area of HB 232. Mr. Phelps explained that he is an
ordained minister, although he's not currently working in
that field, and he spent 15 years of his life as a minister
and was commissioned as a Lt. Colonel in Brigade Chief of
Chaplains in the Alaska State Militia and was appointed by
Governor Cowper to serve on the general staff for two years
as advisor on religious issues.
MR. PHELPS said that during those 15 years he had a number
of opportunities and the responsibility of dealing with
families of the bereaved, and his concern with HB 323 as
written is that one of its primary effects would be to allow
organ banks or storage facilities direct access to the names
of next of kin within the first 24 hours to ask them to
agree to donate parts of their beloved loved one. Mr.
Phelps indicated this is an extremely sensitive time for
these people, and it worries him what effect this type of
intrusion could have on their privacy at a time when they
are in a very vulnerable situation. He said he wanted the
committee to be aware of the fact that in current statute we
require medical personnel to speak to the next of kin and
let them know it is one of their options to donate organs
and other tissues. He concluded that it is not as if people
are not aware of this option, and it causes him a great deal
of concern to think of organ and tissue bank personnel
contacting people in their time of bereavement.
Number 317
REP. TOOHEY commented that the speaker before her had hit on
what the bill is, exactly; the object of the bill is to
allow tissue procurement to happen within a viable time.
She said if you wait for two or three days the tissue is no
longer viable. Rep. Toohey asked Mr. Saakvitne to speak to
this issue after hearing testimony from Dr. Nakamura.
Number 328
DR. PETER NAKAMURA, Director, Division of Public Health,
Department of Health and Social Services (DHSS), testified
in support of HB 323. He said they have had, not only in
the state of Alaska, but across the nation, a great deal of
difficulty in getting enough human tissue for all surgical
replacement needs. Dr. Nakamura explained that the reason
they have not been able to participate in this program much
in the past is that there is language within our legislation
that doesn't allow the release of information that would
allow the tissue program to have early access to the tissue
in time to salvage the usable tissues. Dr. Nakamura said HB
323 allows the state of Alaska and Bureau of Vital
Statistics to release the necessary information to allow
this tissue to be harvested in time.
Number 364
CHAIRMAN PORTER asked if current state law requires or
allows a medical person that is attendant at the death to
advise the next of kin of the opportunity to donate tissue.
MR. PHELPS responded that the law requires it.
REP. TOOHEY explained that she doesn't think Mr. Phelps is
aware of the time frame, and sometimes getting the
information on the death certificate takes up to four days
or longer. She said as an emergency room nurse she has
never had the opportunity to tell [the next of kin of]
someone who has died that they need to consider tissue
transplant. Rep. Toohey said it is not something the
hospital does necessarily, although it is supposed to be
policy, but to her knowledge it has never been done.
Number 399
CHAIRMAN PORTER indicated that the bill would provide that a
tissue facility would be able to have this information and
consequently make a inquiry of the next of kin. He asked if
that would be generally done in circumstances where there is
a needy recipient, or if it would be done in general terms.
Number 405
MR. SAAKVITNE replied that they do not need to tissue match
and type tissues that way. There is normally not a specific
recipient that the tissue is designated for, but there is a
waiting list, and there is a sure guarantee that if humanly
possible it would be used for transplant.
Number 412
REP. KOTT indicated that state law requires hospitals to
inquire about tissue donations, and a policy should already
be in place for hospital personnel. He asked if next of kin
are listed, and if so, what are the procedures for notifying
the next of kin.
Number 429
MR. SAAKVITNE responded that first, there are indeed
statutory requirements for all hospitals to have policies
and procedures that require donation information at the time
of a death, but they are carried out rather infrequently,
and it also doesn't address those individuals that die
outside of a hospital. He indicated that of 41 families he
spoke with over the last year and a half, 31 of those
families have agreed to some type of donation, and he has
yet to have a family for the request. Mr. Saakvitne pointed
out the statute says the coroner may release the
information, but is not required to do so, so if they start
receiving complaints from families, the coroner can stop
releasing the information.
Number 464
CHAIRMAN PORTER asked how, step by step, it would work.
Number 467
MR. SAAKVITNE replied that the coroner's office would
continue to inform him of coroner's deaths, and they would
make an assessment as far as age and medical suitability.
Next, he or another trained counselor would contact the
family and act as an information resource. He continued by
saying they go over what decisions will be taking place over
the next few days and inform them there may be an option of
tissue donation, but inform them there is no wrong decision,
and then leave a phone number and leave it to the family to
call back. Mr. Saakvitne said about half the families
immediately say donation is something they want; another 25
percent call back within a few hours; and the remainder
either don't call at all, or they call for other
information, but decide against donation.
Number 492
REP. GREEN indicated he had a number of questions and asked,
if they are short of tissue, how many people who might be
potential donors die in the hospital as opposed to
elsewhere? What is the prime age group for donors? What
assurances are there that HB 323 won't become a body parts
shop? How is the program working in other states? If the
most likely group to provide tissue is the younger
population, what happens if you can't find the next of kin
in a timely manner? Is it reasonable to expect that you
would receive the information in a timely manner?
Number 533
MR. SAAKVITNE responded that not enough people are made
aware of the tissue donation option. Although many people
may have a donor card, out of the 87 donors last year, only
four had donor cards that could be located.
Number 501
DR. NAKAMURA responded, saying as far as the number of
deaths outside a hospital, he couldn't give a figure, but
the major causes of death in the state would be cancer,
heart disease, and accidents. He continued by saying that
if you go to the healthy population, those under 45, a
disproportionate number die from accidents and violence
outside of hospitals.
Number 533
MR. SAAKVITNE indicated that more tissues can be used for
plasma surgery from younger patients, and the overall age
ranks from full term birth to 70, but age 45 or younger,
many more tissues can be used. He responded in regards to
the body shop question: of other states that have
incorporated this, about 15 states, they have a coroner
call-in system, and in all of those states it is never
mandated that the coroner has to release the information.
If families start to be abused or complaints come in, then
it becomes the moral obligation of the coroner or
departments of health to clean up their act or shut the
organization down and no longer give out information.
MR. SAAKVITNE said the only state he had personal
involvement with was Colorado. The only problem he is aware
of is that at times the coroners felt it was extra work and,
once in awhile, viewed them as a minor pain bothering them
for information. When he left there in 1989, he was unaware
of any complaints from families.
MR. SAAKVITNE then discussed the time question, and said in
some cases they will not be able to reach the families in
time to harvest tissue. Currently, there are a lot of cases
where they don't have the chance at all, and HB 323 would
probably double the number of cases where they are able to
offer the families a reasonable donation option in a
reasonable amount of time.
Number 593
REP. KOTT suggested that if hospitals were in fact following
the procedures in statute, wouldn't that take care of the
back load?
Number 610
MR. SAAKVITNE indicated that it would help, but would still
not be enough.
Number 615
REP. TOOHEY said if there is no immediate need in Alaska for
tissue, it goes to a bank in Seattle and then it is sent
everywhere in the Northwest, so the tissue does not go to
waste.
Number 630
MR. SAAKVITNE concurred and said all tissue is held for 30
days on reserve for Alaska; the exception is corneas, which
have to be used within five days. There are certain tissues
that are used 100 percent of the time in Alaska, such as
tendons, but other tissues, such as heart valves, get used
in the Northwest.
Number 657
REP. KOTT asked Mr. Saakvitne what he was doing to ensure
that he was not violating a person's religious beliefs.
Number 665
MR. SAAKVITNE responded there are no major religions that
are against organ or tissue donation; there are some
cultural beliefs with the Gypsies and certain American
Indian tribes, but no religious beliefs per se. He said,
beyond that, they never try and talk a family into it. They
simply inform them they have several options and donations
is one of them, and there is no wrong decision.
Number 670
REP. KOTT said if an individual was to carry a card at the
time of death, indicating they did not want to be a donor,
what would the subsequent action be.
Number 673
MR. SAAKVITNE replied that they would never contact the
family about donation if that was the case.
Number 675
REP. GREEN asked if Alaska was considered an importer or
exporter of tissues.
Number 683
MR. SAAKVITNE responded that Alaska is an exporter of most
tissues, but with certain things, such as corneas and
tendons, we become importers. With heart valves, we are an
exporter. He noted that within the next six months,
Providence Hospital is going to start transplanting heart
valves, rather than sending patients to Portland, and at
that point Alaska will become an importer of heart valves
also.
REP. GREEN asked what the rejection rate is for tissue.
Number 701
MR. SAAKVITNE said just about all the tissue they are
transplanting does not have blood vessels, which reduces
rejection by about 95 percent. Most of the other five
percent is taken care of by freezing or freeze drying, which
tends to destroy the immunological identity of tissues so
when they are transplanted they are not recognized as
foreign.
REP. PHILLIPS moved to adopt the committee substitute.
Hearing no objection, it was so moved.
Number 720
REP. PHILLIPS moved that the committee move CSHB 323 out of
committee with individual recommendations and zero fiscal
notes. Hearing no objection, it was so ordered.
CSHB 323(JUD) WAS MOVED OUT OF COMMITTEE WITH INDIVIDUAL
RECOMMENDATIONS AND ZERO FISCAL NOTES
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