Legislature(2007 - 2008)CAPITOL 120
03/26/2008 01:00 PM House JUDICIARY
| Audio | Topic |
|---|---|
| Start | |
| HB355 | |
| HB420 | |
| HB368 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 420 | TELECONFERENCED | |
| += | HB 368 | TELECONFERENCED | |
| += | HB 355 | TELECONFERENCED | |
| + | TELECONFERENCED |
HB 420 - ANATOMICAL GIFTS 2:05:11 PM CHAIR RAMRAS announced that the next order of business would be HOUSE BILL NO. 420, "An Act relating to the Uniform Anatomical Gift Act, to anatomical gifts, to donations to the anatomical gift awareness fund, to a registry of anatomical gifts, and to organizations that handle the procurement, distribution, or storage of all or a part of an individual's body." 2:05:46 PM REBECCA ROONEY, Staff to Representative Peggy Wilson, Alaska State Legislature, stated on behalf of Representative Wilson, chair of the House Health, Education and Social Services Standing Committee, sponsor, that HB 420 would update the Alaska Statutes regarding organ donation. She stated that the Uniform Anatomical Gift Act (UAGA) is model legislation that serves to harmonize organ and tissue donation laws in all 50 states. The model legislation has served this function for over 40 years. Alaska statutes that govern organ donation are based on the UAGA. However, the statutes are based on the last significant update in 1997. She stated that HB 420 brings Alaska's statutes in line with the latest version, the 2008 revised UAGA. She offered that the Department of Law (DOL), the Department of Health and Social Services (DHSS), the Office of the State Medical Examiner, Life Alaska Donor Services and a representative of the National Conference of Commissioners on Uniform State Laws (NCCUSL) were involved in the development of the language and so far all are satisfied with the result. Currently, 180 Alaskans are in need of life saving transplants and await the availability of a donated organ and hundreds more await tissue transplants. The bill is a realignment of the statutes and a sectional analysis is in members' packets. 2:08:47 PM DEBORAH BEHR, Chief, Assistant Attorney General, Legislation and Regulations Section, Civil Division (Juneau), Department of Law (DOL); Alaska Uniform Law Commissioner, National Conference of Commissioners on Uniform State Laws (NCCUSL), explained that she is pleased to recommend the adoption of the Uniform Anatomical Gift Act (UAGA). REPRESENTATIVE GRUENBERG related his understanding that the bill is intended to retain uniformity of the current statutes. MS. BEHR pointed out that this bill would place Alaska in line with 20 other states that have adopted the UAGA. She noted that 16 additional legislatures have bills pending that would adopt the UAGA. It is complementary with the laws currently in Alaska. REPRESENTATIVE GRUENBERG asked whether passing HB 420 would destroy the uniformity of the act. MS. BEHR consulted with the national organization and this bill is consistent with what other states are doing. She stressed the importance in the uniformity of the laws with other states since an organ donor may be in one state, the recipient in another, and families residing in other states. REPRESENTATIVE GRUENBERG referred to page 15 lines 21, in proposed AS 13.52.253, which he read: "Except as provided by 13.52.055 ..." He inquired as to whether the uniform law commissioners have considered whether this would destroy the uniform act. MS. BEHR answered that AS 13.52.253 is a provision [having to do with health care decisions during pregnancy] that is unique to Alaska law. However, the uniform law commissioners believe that certain decisions can be reserved by the state. Thus, the decision itself does not destroy the uniformity of how organs are donated. She highlighted that the commission does not delve into the basic decisions such as pregnancy, which would be deferred to the local jurisdiction. 2:12:25 PM REPRESENTATIVE LYNN inquired as to what percentage of gifts go to recipients that need a major organ such as a heart or kidney as opposed gifts for cosmetic or elective surgery. BRUCE ZALNERAITIS, Chief Executive Officer, Life Alaska Donor Services (Life Alaska), offered his understanding that an organ donor would, on average, assist four or five recipients and one tissue donor assists up to 50 tissue recipients. He stated that Alaska averages 200 donors a year, of which 25 are organ and tissue donors combined, and the remainder are tissue donors that do not donate organs. In response to Representative Lynn, Mr. Zalneraitis explained that organ donors donate a vascular organ such as a kidney, liver, heart, lungs, pancreas, or sometimes the small intestine. He stated that organs are vascular and have a blood supply at the time of donation. A tissue donor would donate such items as cornea, skin, orthopedic tissues, and vessels of the leg. Tissue donors donate tissues after the circulation has ceased for up to 24 hours following the cessation of the heart, whereas organs are donated while the heart is still beating, he stated. 2:15:03 PM REPRESENTATIVE LYNN inquired as to whether any part of aborted fetuses is used. MR. ZALNERAITIS answered that his organization does not engage in any research from fetuses and nothing is donated before normal birth. REPRESENTATIVE LYNN inquired as to whether Life Alaska charges a fee for its services. MR. ZALNERAITIS answered that the fees are charged in the same manner as donated blood, which is a fee charged to the recipient for processing. He also explained that fees are charged for tissue transplants related to the processing charges to safely acquire, preserve, and send the tissue to the recipient center. In further response to Representative Lynn, Mr. Zalneraitis confirmed that the processing fees for organ and tissue donation vary. He noted that organs have the highest acquisition fee. 2:16:52 PM REPRESENTATIVE COGHILL offered that this is issue is very dear to him since his own grandson was a donor when he died. He related that his grandson was kept alive for a day and a half in order for him to be a donor. He found the issue of donations between states created the biggest problem for his family. MR. ZALNERAITIS stated that in the case of organ transplants a limited time exists to reestablish blood flow of the organ in the recipient. For example, a heart is viable for 6 hours, a liver is viable for 18 hours, and kidney is viable for approximately 24 to 30 hours from the interruption of blood flow in the donor, he stated. He noted that the time is limited for Alaskan donors and that often the recipient is in the operating room when the heart will arrive at a hospital such as the University of Washington [Medical Center] in Seattle, Washington. 2:18:41 PM REPRESENTATIVE COGHILL inquired as to whether the rules of procedure are currently "out of sync" as compared to those proposed under HB 420. MS. BEHR stated that HB 420 will dramatically improve the donor process because it establishes procedures. She stated that a young child likely did not sign a release and the parents must do that on behalf of the child. This bill will set out a procedure to clearly inform the doctor of the family's wishes to donate the organ or tissue, she stated. She related her understanding that the UAGA has saved lives in other states. MR. ZALNERAITIS, in response to Chair Ramras, explained that organ donors in Alaskans are sent to Seattle, which is where Alaska recipients receive most of their transplants. He stated that of the 180 waiting, approximately 120 are kidney patients awaiting transplants at Virginia Mason Medical Center, Swedish Medical Center, and University of Washington hospitals. He offered that Alaska patients sometimes receive organs from Washington, Idaho, or Montana donor. In further response to Chair Ramras, Mr. Zalneraitis stated that most Alaskans awaiting kidney donations stay in Alaska, on dialysis. However, patients awaiting a lung or heart transplant are frequently unstable patients and may be admitted to a hospital in Washington or are housed nearby awaiting the call that the donor is available. Life Alaska has about 25 donors per year, who donate approximately 100 organs to recipients. 2:22:30 PM REPRESENTATIVE DAHLSTROM noted that she is aware of several people in her community awaiting transplants, including a 10 year old boy named Sean who has been living in Seattle with his mother and sister awaiting a heart transplant. KIM MAGEE stated that she is a recipient of a simultaneous kidney and pancreas donations. She explained that she was a diabetic for 38 years and developed kidney disease, which resulted in kidney failure. Ms. Magee stated that she was on a waiting list for 8 months, which is not a long time to wait for a kidney, she opined. She was residing in Alaska when she received the call that a kidney and pancreas from a Washington state donor was available. She said within a few hours of receiving the call, she was on a plane headed to Seattle. She also wished to point out that she received excellent medical care while in Alaska. Ms. Magee stated that organ donations save lives. 2:27:25 PM SHERRY BADILLO MORENO, Volunteer, Life Alaska, stated that her 17 year old daughter died in 2003 while driving to work. She said her daughter was less than one mile from home when she lost control of her truck and hit two trees and died. She stated that her daughter was a senior at Colony High School, involved in the football program, was a nationally published poet, who spoke of the brevity of life in her poetry. She related some touching personal information about her daughter and her accomplishments. She said that her daughter lives on through her tissue donations that helped 48 people. She related that her daughter died immediately so she was not eligible as an organ donor. However, her heart valve, skin, tissue, and bone were donated to recipients. She characterized tissue donation and organ donation as the "right thing to do." 2:33:57 PM REPRESENTATIVE GRUENBERG referred to page 13, line 16, in proposed subsection (f). He inquired as to whether a minor has a constitutional right to determine what to do with their own body. MS. BEHR answered that when a minor applies for a driver's license, that the minor needs parental consent. As a part of that a form, the bottom of the card allows for consent to organ donation. A parent is not involved in that decision making process. However, subsection (f), is designed to allow parents to make final decisions and revoke or amend consent for instances in which a minor in the custody of his/her parents has given consent for organ donation. REPRESENTATIVE GRUENBERG inquired as to whether that is constitutional because it seems to him that the minor has a right to determine what to do with his/her own body and that the state should provide a method to effectuate it regardless of whether the child obtains a driver's license. He opined that this is an important constitutional question that needs to be addressed, although he offered that he did not need an immediate answer to his question. He referred to page 14 lines 5-7, in proposed subsection (i), which bans the attending physician at the death of a donor from participating in the removal of organs. He said that in many rural areas with only one doctor this may pose problems and offered that this subsection may need an Alaskan exception. MR. ZALNERAITIS answered that when a death occurs, it is Life Alaska's responsibility to arrange transportation to those rural areas. He stated that in no circumstance would Life Alaska want or expect a physician who was involved in the care of the patient and the declaration of death to participate in the donation procedure. He stated the donation procedures would instead be carried out by Life Alaska's team and their colleagues in Seattle and that Life Alaska would arrange for the necessary transportation. REPRESENTATIVE GRUENBERG inquired as to whether vagaries of Alaska weather and the need for quick harvesting of donor organs enters into the process such that the bill may need to be "a bit looser" to provide for medical necessity. MR. ZALNERAITIS said that the practicality of organ donation and the reality of medical conditions to allow for organ donation would require that any patient be transferred to a hospital that has the capability to provide services to maintain the donor prior to a transplant that are not available in rural areas. He pointed out that if it was not possible to do maintain the donor's life, that the person could be a tissue donor. 2:40:14 PM JAY BUTLER, M.D., Chief Medical Officer, Office of the Commissioner, Department of Health and Social Services (DHSS), concurred with Mr. Zalneraitis. Dr. Butler elaborated that the process of organ and tissue harvesting is highly technical and specialized. He stated that primary care physicians in rural areas do not have training or equipment to do so and he thought that it would raise questions about the standard of care and whether it could be achieved in those settings. REPRESENTATIVE GRUENBERG offered his strong support for HB 420. He stated that he just wanted to ensure that the bill addresses Alaska's situation since Alaska is so large with few physicians. He offered his goal is to avoid having the matter come back to the legislature in order to accommodate medical technological advances. DR. BUTLER opined that he did not see that happening in the near future. REPRESENTATIVE GRUENBERG characterized his comments on the minor's right to choose as an attempt to be helpful. 2:42:00 PM MIKE GERAGHTY, Attorney, Alaska Uniform Law Commissioner, National Conference of Commissioners on Uniform State Laws (NCCUSL), explained that the original act was passed in 1968 and was enacted by all 50 states and the District of Columbia. He stated that HB 420 incorporates changes in the revised UAGA, which was just promulgated by the NCCUSL in 2006. Since then the revised act has been adopted in at least 22 states, which represents very fast action on the part of those states. MR. GERAGHTY highlighted changes in the revised act. The first person consent to make a donation of organ and tissue has been substantially strengthened to bar others from interfering or attempting to revoke the gift. By the same token, if a person has entered into a refusal, the act also protects that person's right not to make a gift. He pointed out that absent first person consent, in which the deceased has neither consented nor refused to make a gift, the revised act facilitates gifts by family members and health care agents by expanding those who can act to make a gift on a person's behalf to include health care agent. This bill also clarifies the manner in which that consent must be contained and outlines the circumstances. Gifts on donor registries and state issued identification cards are specifically authorized under HB 420. Registries are encouraged and operation standards are provided since many stated did not have donor registries. He pointed out that the state adopted a uniform state registry a few years ago that has been very successful. This bill provides for cooperation and coordination between procurement organizations and medical examiners specifically with regard to procurement from potential donors under the jurisdiction of the medical examiner. MR. GERAGHTY concluded that HB 420 harmonizes federal law with current practices including the use of advanced medical directives, such as do not resuscitate orders. He stated that the revised act has been endorsed by the American Medical Association (AMA), the American Bar Association (ABA), the American Academy of Ophthalmology, the American Association of Tissue Banks, the American Society of Cataract and Refractive Surgery, the Association of Organ Procurement Organizations, the federal Health and Human Services Advisory Committee on Organ Transplantation, the Cornea Society, and the Eye Bank Association of America. He strongly encouraged the committee to act on HB 420. 2:47:17 PM CHAIR RAMRAS, after first determining no one else wished to testify, closed public testimony on HB 420. REPRESENTATIVE GRUENBERG expressed an interest in having HB 420 held over so that he could research the matter of the minor, but he deferred to Chair Ramras. CHAIR RAMRAS expressed his preference for moving HB 420 out of committee. 2:48:49 PM REPRESENTATIVE DAHLSTROM moved to report HB 420 out of committee with individual recommendations and the accompanying fiscal notes. There being no objection, HB 420 was reported from the House Judiciary Standing Committee.
| Document Name | Date/Time | Subjects |
|---|