HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: CS/HB 677 Organ Donation
SPONSOR(S): Health & Human Services Committee, Berfield
TIED BILLS: IDEN./SIM. BILLS: SB 646
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Health & Human Services Committee 21 Y, 0 N, As CS Osborne Calamas
2) Ways & Means Committee
3) Infrastructure Strategies Committee
4) Appropriations Committee
SUMMARY ANALYSIS
Organ donation is the process of surgically removing an organ or tissue from one person (the donor) and
transplanting it into another person (the recipient). Transplanting in such cases is necessary because the
recipient’s organ has failed or has been damaged by disease or injury. Transplantable organs include the liver,
kidneys, pancreas, heart, lung, and intestine. Transplantable tissues include skin, bone, heart valves, tendons,
veins, and corneas.
Although most organ donations occur after death of the donor, some donations come from living organ donors.
A living-donor transplant is a surgical procedure to remove an organ or portion of an organ from a living person
and place it another person whose organ is no longer functioning. Some living organ donors have difficulty
obtaining various types of insurances.
CS/HB 677 amends multiple sections of law related to organ donation.
The bill creates a category of administrative leave for organ donation for employees of the state or a political
subdivision thereof.
The bill requires locations where recreational licenses or permits are sold to display and make available to the
public educational materials relating to organ donation and registration. The bill requires the Florida Fish and
Wildlife Conservation Commission to maintain an integrated link on its website referring a visitor applying for a
hunting, fishing, or trapping license to the organ donor registry.
The bill amends the Florida Insurance Code to prohibit preexisting condition exclusions that have the effect of
limiting or denying coverage to a living organ donor.
The bill requires certain driver improvement schools and DUI programs provide students with information
pertaining to organ donation. The bill directs the Department of Transportation to adopt rules to implement this
provision.
The bill requires Donate Life to coordinate with the Department of Health to ensure that continuing education
topics on organ donation are available to medical professionals.
The bill has an insignificant, negative fiscal impact on state government. The bill has no impact on local
governments.
The bill provides an effective date of July 1, 2024.
This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives .
STORAGE NAME: h0677a.HHS
DATE: 1/23/2024
 FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Background
Organ and Tissue Donation
Organ and tissue donation is the process of surgically removing an organ or tissue from one person
(the donor) and transplanting it into another person (the recipient). Transplanting in such cases is
necessary because the recipient’s organ has failed or has been damaged by disease or injury.1
Transplantable organs include the liver, kidneys, pancreas, heart, lung, intestine. 2 Transplantable
tissue include skin used as a temporary dressing for burns, serious abrasions and other exposed
areas; bone is used in orthopedic surgery to facilitate healing of fractures or prevent amputation; heart
valves are used to replace defective valves; tendons are used to repair torn ligaments on knees or
other joints; veins are used in cardiac by-pass surgery; and corneas can restore sight.3 A single organ
donor can save up to eight lives and over seventy-five more can be improved through organ donation.4
Despite advances in medicine and technology, and increased awareness of organ donation and
transplantation, more donors are needed to meet the demand for transplants.5 As of January 2022,
120,000 children and adults are waiting for a life-saving organ transplant, including 5,000 Floridians. 6 In
2021, 41,354 organ transplants were performed in the United States, reflecting an increase of 5.9
percent from 2020.7 Living donor transplants on the other hand significantly decreased in 2020 due to
COVID-19. While they increased in 2021, the numbers remain lower than in previous years. In 2021, a
total of 6,541 living donor transplants were performed nationwide
Living Organ Donation
Although most organ donations occur after the death of the donor, some donations come from living
organ donors. A living-donor transplant is a surgical procedure to remove an organ or portion of an
organ from a living person and place it in another person whose organ is no longer functioning
properly.8 Kidney and liver transplants are the most common living-organ procedures, though a living
organ donor can also donate tissues for transplants such as skin, bone marrow, and stem cells to
replace organs or tissue that have been damaged or destroyed by disease, drugs or radiation.9
Based on the limited data available on the long-term risks of living organ donors currently available, the
overall risks are considered to be low and differ among donors depending on the organ donated. 10
Short-term risks of living organ donation involve risks associated with anesthesia and major surgeries,
including pain, infection, blood loss, blood clots, allergic reactions to anesthesia, pneumonia, injury to
surrounding tissue or organs, and death.11
1
Cleveland Clinic, Organ Donation and Transplantation. Available at https://my.clevelandclinic.org/health/articles/11750-organ-
donation-and-
transplantation#:~:text=Organ%20donation%20is%20the%20process%20of%20surgically%20removing,one%20of%20the%20great%2
0advances%20in%20modern%20medicine (last visited January 20, 2024).
2 Id.
3
Donate Life Florida, Frequently Asked Questions Available at https://www.donatelifeflorida.org/categories/donation/ (last visited
January 20, 2024).
4 Health Resources and Services Administration, What Can Be Donated? Available at https://www.organdonor.gov/learn/what-can-be-
donated (last visited January 14, 2022). https://optn.transplant.hrsa.gov/data/ (last visited January 20, 2024).
5 U.S. Department of Health and Human Services, Organ Procurement and Transplantation Network . Available at All-time records
again set in 2021 for organ transplants, organ donation from deceased donors - OPTN (hrsa.gov) (last visited January 20, 2024).
6 Supra, note 3.
7 Supra, note 5.
8 Mayo Clinic, Living-donor transplant. Available at https://www.mayoclinic.org/tests-procedures/living-donor-transplant/about/pac-
20384787 (last visited January 20, 2024).
9 Id.
10 UNOS, How do I b ecome a living donor? Available at https://unos.org/transplant/living-donation/ (last visited January 20, 2024).
11 Id.
STORAGE NAME: h0677a.HHS PAGE: 2
DATE: 1/23/2024
 National Organ Transplant Act of 1984
The National Organ Transplant Act of 1984, which regulates organ donations including living organ
donors, prohibits the buying and selling of organs.12 Living donation of an organ must be voluntary, and
the donor cannot receive payment. While, the organ recipient’s health insurance covers medical
expenses such as evaluation, surgery, and limited follow-up test and medical appointments depending
on the particular insurance, the recipient’s insurance will not cover transportation, lodging, childcare, or
lost wages.13 In addition, treatment for conditions discovered during the evaluation portion of the
donation process and some post-donation follow-up expenses are not covered.14
The United Network for Organ Sharing (UNOS), is a non-profit organization under contract with the
federal government to manage the national transplant waiting list and maintaining the databases
containing all organ transplant data for every transplant event occurring in the U.S. 15, UNOS warns
prospective donors that some donors report, “difficulty in getting, affording, or keeping health, disability,
or life insurance.”16
Regulation of Organ Donation, Procurement, and Transplantation in Florida
The Agency for Health Care Administration (AHCA) oversees the various organizations and facilities
involved in the organ procurement and transplant process in this state. AHCA licenses transplant
facilities, contracts with an organization to educate the public on organ donation, sets requirements for
training individuals who engage with families whose deceased relatives may be a good candidate for
organ donation, and supports the Organ Transplant Advisory Council and the Organ and Tissue
Procurement and Transplantation Advisory Board.
Organ Donor Registry
In 2008,17 Florida’s Legislature found that a shortage of organ and tissue donors existed in Florida.
Findings included a need for:
 A statewide donor registry with online donor registration capability; and
 Enhanced donor education, to increase the number of organ and tissue donors.
The online registry would afford more persons who are awaiting organ or tissue transplants the
opportunity for a full and productive life.18 As directed by the legislature, AHCA and the Department of
Highway Safety and Motor Vehicles (DHSMV) jointly contracted for the operation of Florida’s interactive
web-based donor registry that allows for online donor registration and the recording of organ and tissue
donation records submitted through the driver license identification program or through other sources.
AHCA and the DHSMV selected Donate Life Florida, which is a coalition of Florida’s organ, tissue, and
eye donor programs, to run the donor registry and maintain donor records.
Floridians who are age 18 or older can join the donor registry either online, at the DHSMV (or their local
driver license office), or by contacting Donate Life Florida for a paper application.19 Children ages 13 to
17 may join the registry, but the final decision on any organ donation of a minor rests with the parent or
guardian. The registry collects personal information from each donor including, but not limited to, his or
her name, address, date and place of birth, race, ethnicity, and driver’s license number.
12 National Organ Transplant Act, 42 U.S.C. s. 274.
13 UNOS, Financial and Insurance Factors to Consider. Available at https://unos.org/transplant/living-donation/ (last visited January 20,
2024).
14 Id.
15 Id.
16 Id.
17 Ch. 2008-223, Laws of Fla.
18 S. 765.5155(1), F.S.
19 Donate Life Florida, Welcome to the Joshua Ab b ott Organ and Tissue Donor Registry. Available at http://www.donatelifeflorida.org/
(last visited January 20, 2024)
STORAGE NAME: h0677a.HHS PAGE: 3
DATE: 1/23/2024
 As of March 3, 2021, there were 11,468,537 people registered in the donor registry.20
A person may make an anatomical gift of all or part of his or her body by:21
 Signing an organ and tissue donor card;
 Registering online with the donor registry;
 Signifying an intent to donate on his or her driver license or identification card issued by the
DHSMV;22
 Expressing a wish to donate in a living will or other advance directive;
 Executing a will that includes a provision indicating that the testator wishes to make an
anatomical gift;23 or
 Expressing a wish to donate in a document other than a will.24
Donor Education
When a patient dies in a hospital and is not a registered organ donor, but is determined to be a good
candidate by the hospital’s medical staff and the OPO, a representative of the OPO or a member of the
hospital’s staff may approach the patient’s family about organ donation. 25 AHCA has developed rules
for training and guidelines for the person making the request for organ donation. 26 The requestor is
trained in explaining the process of organ donation to the patient’s family, including their right to allow
or refuse donation and for what purpose the organs would be donated (transplantation, research, or
education).27 The requestor is also specifically trained in the different types of approaches to deal with
a family’s grief and offering them the opportunity for organ donation. 28 The current rules require the
requestor to explain the requirements needed to be met under Florida law in order for a donation to be
allowed, but not federal regulations relating to organ donation.
Organ Donation Fees
Generally, an organ donor and their family are not charged by a transplant facility for the medical care
required to donate an organ.29 Families pay for medical care and funeral costs, but costs related to
living or deceased donation are paid by the recipient, usually through insurance, Medicare, or
Medicaid.30 Typically, any cost that falls outside of the transplant center’s donor evaluation or actual
surgery, such as travel, lodging, lost wages, and other non-medical expenses, is borne by the living
donor or recipient.31
Living Organ Donors and Insurance
Obtaining and Affording Insurance
20 Id.
21 S. 765.514(1), F.S.
22 Revocation, suspension, expiration, or cancellation of the driver license or identification card does not invalidate the gift .
23
The gift becomes effective upon the death of the testator without waiting for probate. If the will is not probated or if it is declared
invalid for testamentary purposes, the gift is nevertheless valid to the extent that it has been acted upon in good faith.
24 The document must be signed by the donor in the presence of two witnesses who shall sign the document in the donor’s presence. If
the donor cannot sign, the document may be signed for him or her at the donor’s direction and in his or her presence and the presence
of two witnesses who must sign the document in the donor’s presence. Delivery of the document of gift during the donor’s lifetime is not
necessary to make the gift valid.
25 Health Resources and Services Administration, The Deceased Donation Process. Available at
https://www.organdonor.gov/about/process/deceased-donation.html#authorize (last visited January 20, 2024). See also s. 765.522,
F.S.
26 Ch. 59A-3.274, F.A.C.
27 Id.
28 Id.
29 Health Resources Services Administration, Organ Donation Frequently Asked Questions. Available at
https://www.organdonor.gov/about/facts -terms/donation-faqs.html (last visited January 20, 2024).
30 Id. See also UNOS, Living Donation Costs. Available at https://transplantliving.org/financing-a-transplant/living-donation-costs/ (last
visited January 20, 2024).
31 UNOS, Living Donation Costs. Available at https://transplantliving.org/financing-a-transplant/living-donation-costs/ (last visited
January 20, 2024).
STORAGE NAME: h0677a.HHS PAGE: 4
DATE: 1/23/2024
 A 2014 survey of 1,046 donors who underwent living kidney donation at Johns Hopkins Hospital found
that, 25 percent of those who reported attempting to obtain new or revised life insurance policies post-
procedure reported difficulty in doing so. The difficulties reported included outright denials in obtaining
coverage, higher premiums, and the notation of a pre-existing condition relating to the kidney donation.
The same survey also noted that of the donors who reported attempting to obtain new or revised health
insurance policies post-procedure, seven percent reported difficulties in doing so.32
Another study, which reviewed different studies over a 35-year period concluded that a significant
number of living kidney donors encounter difficulties in obtaining or maintaining insurance (with
anywhere between three percent to eleven percent of those surveyed reporting difficulties).33 That
same study also found that insurability issues caused significant stress for between 11 percent and 13
percent of kidney donors and that “insurability may negatively influence one’s decision to become a
living organ donor.”34 This same study also found that these insurability issues are not isolated to
kidney donors.35 The National Kidney Foundation also advises potential donors, in assessing the risk of
donation, that “some donors have reported difficulty in getting, affording, or keeping disability or life
insurance.”
There is some evidence that these increased difficulties and costs in obtaining life insurance is not
always based on the actual additional loss risk that organ donation presents. A 2015 study of living
kidney donors found that such donation “does not appear to increase long-term mortality compared
with controls;” however, the study did advise that it was limited in scope and more research was
needed.36 A study of living kidney donors in Korea, published in 2019, found that,“ the risk of all-cause
mortality was comparable between live kidney donors and matched non-donor healthy controls with
similar health status.”37 A 2012 study of live liver donors found that while 90-day mortality rates were
elevated for such donors, t