S.F. _____ Section 1. NEW SECTION . 142E.1 Definitions. 1 As used in this chapter, unless the context otherwise 2 requires: 3 1. “Altruistic living donor registry” or “living donor 4 registry” means the registry established in section 142E.2 to 5 promote and assist live organ donations. 6 2. “Department” means the department of public health. 7 3. “Directed donation” means a donation pursuant to which 8 a living donor provides an organ for a known transplant 9 candidate. 10 4. “Iowa donor network” means the Iowa donor network as 11 defined in section 142C.2. 12 5. “Iowa donor registry” means the Iowa donor registry as 13 defined in section 142C.2. 14 6. “Nondirected donation” means a donation pursuant to 15 which a living donor does not identify a specific recipient and 16 donates to any recipient who is a medical match. 17 7. “Organ procurement organization” means organ procurement 18 organization as defined in section 142C.2. 19 8. “Paired exchange” means a donation pursuant to which the 20 registry assists a living donor and a transplant candidate who 21 are medically incompatible to find another living donor and 22 transplant candidate pair facing the same issue and to allow 23 the donors to exchange recipients. 24 9. “Registrar” means the administrator of the altruistic 25 living donor registry. 26 10. “Transplant hospital” means a transplant hospital as 27 defined in section 142C.2. 28 Sec. 2. NEW SECTION . 142E.2 Altruistic living donor 29 registry. 30 1. The director of public health shall contract with and 31 recognize the Iowa donor registry to establish and maintain an 32 altruistic living donor registry. The living donor registry 33 shall contain information regarding individuals who have 34 identified themselves as altruistic living kidney donors. The 35 -1- LSB 2031XC (3) 84 pf/nh 1/ 7

S.F. _____ living donor registry shall be designed to promote and assist 1 live kidney donations, including but not limited to directed 2 donations, paired exchanges, and nondirected donations. The 3 registrar administering the altruistic living donor registry 4 shall develop methods to increase the number of donors who 5 enroll in the registry. 6 2. The registrar shall make available to the federally 7 designated organ procurement organizations and transplant 8 hospitals in the state, information contained in the registry 9 regarding potential donors. This information shall be used to 10 expedite a match between identified organ donors and potential 11 recipients. 12 3. The registrar may receive voluntary contributions to 13 support the registry and its activities. Any contributions 14 received shall be deposited in the altruistic living donor fund 15 created in section 142E.3. 16 4. The registrar shall collect and make all of the following 17 information relating to altruistic kidney donations available 18 to the public: 19 a. The number of donors on the registry. 20 b. The changes in the number of donors on the registry. 21 c. The general characteristics of the donors. 22 5. At such time as the centers for Medicare and Medicaid 23 services of the United States department of health and human 24 services and the united network for organ sharing determine 25 that a donation is generally regarded as safe and without a 26 significant risk of complications, and would not adversely 27 affect the health of the donor, the registrar may expand the 28 altruistic living donor registry to include individuals who 29 identify themselves as altruistic living donors of organs 30 and tissue other than kidneys. Any such expansion shall be 31 reported by the department in the annual altruistic living 32 donor report pursuant to subsection 6. 33 6. The department shall prepare and submit a report to 34 the governor and the general assembly, annually, on or before 35 -2- LSB 2031XC (3) 84 pf/nh 2/ 7

S.F. _____ January 1, regarding altruistic living donor donation. The 1 report shall contain all of the following: 2 a. An evaluation of living donor donation in the state, 3 including statistics regarding donor donation activity as of 4 September 30 of the preceding year. 5 b. Efforts in the state to increase living donor donation. 6 c. Annual contribution levels to the altruistic living donor 7 fund and any distributions made from the fund. 8 d. Efforts and ideas for increasing public awareness of the 9 option of living donor donation. 10 e. Additional information deemed relevant by the department 11 in assessing the status and progress of living donor donation 12 efforts in the state. 13 Sec. 3. NEW SECTION . 142E.3 Altruistic living donor fund. 14 1. An altruistic living donor fund is created as a separate 15 fund in the state treasury under the control of the department. 16 The fund shall consist of any appropriations or contributions 17 made to the fund for the purpose of the fund. 18 2. The moneys collected under this section and deposited in 19 the fund are appropriated to the department for the purpose of 20 administering the altruistic living donor registry established 21 in section 142E.1. Moneys in the fund shall not be subject to 22 appropriation or expenditure for any other purpose. 23 3. The treasurer of state shall act as custodian of the fund 24 and shall disburse amounts contained in the fund as directed 25 by the department. The treasurer of state may invest the 26 moneys deposited in the fund. Notwithstanding section 12C.7, 27 interest or earnings on moneys in the fund shall be credited 28 to the fund. Notwithstanding section 8.33, moneys credited to 29 the fund that remain unexpended or unobligated at the end of a 30 fiscal year shall not revert to any other fund. 31 Sec. 4. NEW SECTION . 321.183A Application for driver’s 32 license or nonoperator’s identification card —— active choice 33 anatomical gift donation. 34 1. a. The application for a driver’s license or 35 -3- LSB 2031XC (3) 84 pf/nh 3/ 7

S.F. _____ nonoperator’s identification card or renewal of a driver’s 1 license or nonoperator’s identification card shall contain a 2 space for the applicant to indicate choice of enrollment as an 3 anatomical gift donor on the Iowa donor registry as defined in 4 section 142C.2. 5 b. The application shall include the following language to 6 allow an applicant to indicate the applicant’s preference: 7 ___ Yes, add my name to the Iowa donor registry. 8 ___ I do not wish to register at this time. 9 Marking “yes” adds your name to the Iowa donor registry and an 10 indication will appear on your license or card. If you wish to 11 remove your name from the registry you must contact the Iowa 12 donor registry. The department can remove the indication from 13 your license or card, but cannot remove you from the registry. 14 If you mark “yes” to register as an anatomical gift donor, 15 you are legally authorizing the recovery of organs and tissues 16 in the event of your death. Registering as a donor will not 17 affect your medical treatment in any way. As outlined in the 18 Iowa Revised Uniform Anatomical Gift Act, Iowa Code chapter 19 142C, your authorization is legally binding if your donation 20 complies with the Iowa Revised Uniform Anatomical Gift Act. 21 You may limit your donation to specific organs or tissues, 22 place usage restrictions, for example transplantation or 23 research, obtain more information about donation, or remove 24 your name from the registry. 25 2. The department shall inquire verbally of an applicant 26 applying in person as to whether the applicant wishes to enroll 27 as an anatomical gift donor. Failure or refusal to answer 28 the question or to check a box on the application form is not 29 a basis for denial of a driver’s license or nonoperator’s 30 identification card. 31 3. A minor may register as a donor if the minor is 32 emancipated or if the minor is authorized under state law to 33 apply for a driver’s license or identification card because 34 the minor is at least fourteen years of age, and the minor 35 -4- LSB 2031XC (3) 84 pf/nh 4/ 7

S.F. _____ authorizes registration as a donor with the signed approval of 1 a parent or guardian. 2 4. On a weekly basis, the department shall electronically 3 transmit to the Iowa donor registry, as defined in section 4 142C.2, all of the following information from every application 5 that indicates the applicant’s decision to enroll in the Iowa 6 donor registry. 7 a. The applicant’s true full name. 8 b. The applicant’s residence or mailing address. 9 c. The applicant’s year of birth. 10 d. The applicant’s driver’s license number or identification 11 card number. 12 5. The director shall adopt rules to administer this 13 section. 14 EXPLANATION 15 This bill relates to organ and tissue donation through 16 anatomical gifts and living donor donations. 17 The bill directs the director of public health to contract 18 with and recognize the Iowa donor registry to establish and 19 maintain an altruistic living donor registry. The living 20 donor registry is to contain information regarding individuals 21 who have identified themselves as altruistic living kidney 22 donors, and is to be designed to promote and assist live kidney 23 donations, including directed donations, paired exchanges, 24 and nondirected donations. The registrar administering the 25 altruistic living donor registry is directed to develop methods 26 to increase the number of donors who enroll in the registry. 27 The bill requires the registrar to make available to the 28 federally designated organ procurement organizations and 29 transplant hospitals in the state, information contained in the 30 registry regarding potential donors. This information must 31 be used to expedite a match between identified organ donors 32 and potential recipients. The registrar is required to make 33 certain information available to the public including the 34 number of donors on the registry; changes in the number of 35 -5- LSB 2031XC (3) 84 pf/nh 5/ 7

S.F. _____ donors on the registry; and the general characteristics of the 1 donors. 2 The bill provides that at such time as the centers for 3 Medicare and Medicaid services of the United States department 4 of health and human services and the united network for organ 5 sharing determine that a donation is generally regarded as safe 6 and without a significant risk of complications, and would 7 not adversely affect the health of the donor, the registrar 8 may expand the altruistic living donor registry to include 9 individuals who identify themselves as altruistic living donors 10 of organs and tissue other than kidneys. Any such expansion 11 is required to be reported by the department of public health 12 (DPH) in the annual altruistic living donor report. 13 The bill directs DPH to prepare and submit a report to the 14 governor and the general assembly, annually, on or before 15 January 1, regarding altruistic living donor donation, and 16 specifies the information to be included in the report. The 17 bill also establishes an altruistic living donor fund as a 18 separate fund in the state treasury under the control of DPH 19 and appropriates the moneys in the fund to DPH for the purposes 20 of administering the altruistic living donor registry. 21 The bill also provides for active choice in making an 22 anatomical gift by specifying language to be included on 23 an application for a driver’s license or nonoperator’s 24 identification card or renewal of a driver’s license or 25 nonoperator’s identification card. Under the bill, the 26 application is to contain a space for the applicant to indicate 27 choice of enrollment as an anatomical gift donor on the Iowa 28 donor registry by including boxes for an applicant to mark 29 one of the following: “yes, add my name to the Iowa donor 30 registry”; or “I do not wish to register at this time”. The 31 bill also requires the department of transportation to inquire 32 verbally of an applicant applying in person as to whether 33 the applicant wishes to enroll as an anatomical gift donor. 34 Failure or refusal to answer the question or to check a box on 35 -6- LSB 2031XC (3) 84 pf/nh 6/ 7

S.F. _____ the application form is not a basis for denial of a driver’s 1 license or nonoperator’s identification card. The bill also 2 specifies the language to be included on the application 3 relating to anatomical gift donation. The bill directs the 4 department, on a weekly basis, to electronically transmit 5 to the Iowa donor registry specific information relating to 6 the information provided by the applicant and directs the 7 director of the department of transportation to adopt rules to 8 administer the provisions of the bill. 9 -7- LSB 2031XC (3) 84 pf/nh 7/ 7