BILL ANALYSIS
SENATE HEALTH AND HUMAN SERVICES
COMMITTEE ANALYSIS
Senator Diane E. Watson, Chairperson
BILL NO: AB 3145
AUTHOR: Granlund
AMENDED: May 16, 1996, and as Proposed to be Amended
in Committee
HEARING DATE: June 26, 1996
FISCAL: Appropriations
CONSULTANT:
Miller
SUBJECT
Coroneros Inquests: Organ Donation
INTENT
This bill seeks to increase the number of organs available
for transplant.
ABSTRACT
Makes numerous findings regarding the need for donation of
organs; finds the San Bernardino protocol extremely
beneficial to increasing organ donations and states
intent to encourage similar protocols.
Authorizes coroners to enter into agreements with one or
more procurement organizations to coordinate organ
recovery and permits acceptance of private assistance to
provide education and training for coroner personnel.
Requires organ procurement organizations to develop the
protocol in conjunction with entering into any agreement
with any coroner or medical examiner, except in any
county that does not have a Level II trauma facility.
Requires the protocol to include, among other things:
a)Relevant information on the deceased to be given to the
coroner at the time of initial request to recover organs,
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as specified;
b)Specific information to be recorded by the organ
procurement coordinator at the time of requesting
permission for organ removal, as specified, including the
coroneros given reason for refusal;
c)A checklist of information relating to the condition of
the deceasedos body to be completed by the OPO
coordinator prior to recovery; and
d)A form to be completed by those performing the organ
recovery procedure, that describes the state of the
deceasedos body, tissues or organs, as specified.
FISCAL IMPACT
According to the Assembly Appropriations Committee
analysis, this bill would have no discernible state fiscal
impact.
Local costs to coroners to approve procurement agency
protocols would likely be minor and absorbable. Any net
costs would be potentially state reimbursable. The
Department of Finance believes that by requiring law
enforcement officials to provide information, the bill
would likely result in unknown, but potentially significant
costs.
BACKGROUND AND DISCUSSION
This measure proposes a methodology intended to increase
the number of organ and tissue donations recovered from
bodies under the coroneros authority. While the number of
patients receiving transplants increased by 49% between
1988 and 1994 (12,786 vs. 19,017), donors increased by only
37% (5,908 vs. 8,114), and the number of patients on the
waiting list more than doubled (27,644 vs. 56,066,
including those who were transplanted, died, or were
removed from the list for other reasons), according to the
1995 Annual Report of the US Scientific Registry of
Transplant Recipients published by the United Network for
Organ Sharing (UNOS). The report indicated that the
widening gap between donors and those waiting for organs
became even deadlier -- in 1994, 3,072 patients died while
waiting.
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Studies indicate that the availability of donated organs
could be significantly increased by recovering organs
currently lost through coroner denial. According to the
Association of Organ Procurement Organizations,
approximately 70% of all potential organ donor cases are
within the jurisdiction of the county coroner/medical
examiner. They also indicate that approximately 40% of
coroner/medical examiner cases were denied in 1992.
In addition to the Uniform Anatomical Gift Act, counties
may have their own guidelines and procedures for organ
recovery in coroneros cases. The level of awareness and
understanding of the Act and relevant guidelines also
varies. According to sponsor Ron Ranus, he and his wife
were unable to donate their daughteros organs after her
accidental death because a deputy coroner was not familiar
with organ donation laws and procedures. As a result of
this experience, they established oCassieos Friends,o an
organ donor educational non-profit organization.
In 1991, San Bernardino County developed and implemented a
protocol for organ recovery for transplantation in
coroneros cases. According to a 1993 evaluation in The
Journal of Heart and Lung Transplantation, San Bernardino
County increased organ donations by 60% as a result of
implementing the protocol. For five years, the protocol
has been in place without significant problems.
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As reported in The Journal of American Medicine, November
1994, several states have laws requiring coroners to
perform autopsies in a manner consistent with preserving
organs and tissues for transplant. These laws specify that
if the coroner believes that the tissues or organs are
involved in the cause of death, he or she may request a
biopsy or deny removal of the organ. In these cases, the
coroner must justify the denial in writing. The same
report determined that in 1992, there were 10 geographic
locations in the U.S. where every medical examiner/coroner
case was released for organ recovery. An extensive review
revealed no case in which a state was unable to adequately
investigate a crime or prosecute a criminal because organ
donation had damaged evidence. There were also no cases
where removing organs for donation rendered a subsequent
autopsy so deficient that the cause of death could not be
determined.
Proponents assert that this bill will result in adoption of
protocols that will reduce denials in coronerso cases,
thereby generating a greater supply of organs for
transplant. In addition, it is argued that allowing the
coroner to accept assistance to educate and train staff in
the timely determination of the cause of death will also
promote the release of organs in coronerso cases.
Opponents argue that this bill would eliminate or severely
impair efforts of coroners and law enforcement personnel to
document and preserve evidence. It is argued that the
incident in Redlands, while unfortunate, was an isolated
one and that coroners generally have good working
relationships with organ procurement organizations and make
every effort to release organs for donation as appropriate.
It is also asserted that the additional responsibility of
documenting, in writing, the reason a coroner may not want
to release an anatomical gift is unnecessary and
burdensome.
PRIOR ACTIONS
Assembly Floor: Pass.(69-0)
Assembly Appropriations: Do Pass.(16-0)
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Assembly Health: Do Pass.(12-0)
POSITIONS
Support: Hoffmann-La Roche, Inc. (Sponsor)
Ron Ranus (Sponsor)
California Dialysis Council
California Healthcare Association
Oppose: California Sheriffso Association
Los Angeles County Coroner
Department of Finance
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