Legislative proposals to help living kidney donors

 Martha Gershun brings us up to date on various proposed pieces of legislation to help organ donors and increase access to transplants.

Legislative Efforts to Support Living Kidney Donors,  by Martha Gershun, Guest Blogger

"As a member of the Expert Advisory Panel to the Kidney Transplant Collaborative, I have been honored to provide input during the development of the organization’s priority legislation, the Living Organ Volunteer Engagement (LOVE) Act.  This legislation would help build a comprehensive national living organ donor infrastructure that would support a national donor education program, create a donor navigator system, ensure appropriate donor cost reimbursement, collect essential data, and improve all aspects of living organ donation across the country, substantially reducing barriers that limit participation today.

Key provisions of the LOVE Act would:

• Provide reimbursement for all direct and indirect costs for living donation, including lost wages up to $2,500 per week.
• Provide life and disability insurance for any necessary care directly caused by donation.
• Modify NLDAC rules so neither the recipient’s income nor the donor’s income would be considered for eligibility.
• Provide for new public education program on the importance and safety of living organ donation.
• Provide for new mechanisms to collect and analyze data about living organ donation to enable evidence-based continuous process improvement.

Numerous other federal proposals are also currently vying for support to address barriers to living donation on a national level.  They include:

Living Donor Protection Act (H.R. 2923, S. 1384)

• Prohibits insurance carriers from denying, canceling, or imposing conditions on policies for life insurance, disability insurance, or long-term care insurance based on an individual’s status as a living organ donor.
• Specifies that recovery from organ donation surgery constitutes a serious health condition that entitles eligible employees to job-protected medical leave under the Family and Medical Leave Act.

Organ Donor Clarification Act (H.R. 4343)

• Clarifies that reimbursement to living organ donation is not “valuable consideration” (I.e., payment), which is prohibited under the National Organ Transplant Act (NOTA)
• Allows pilot programs to test non-cash compensation to living organ donors.
• Modifies NLDAC rules so the recipient’s income would no longer be considered for eligibility.

Living Organ Donor Tax Credit Act (H.R. 6171)

• Provides a $5,000 federal refundable tax credit to offset living donor expenses.

Honor Our Living Donor (HOLD) Act (H.R. 6020)

• Modifies NLDAC rules so the recipient’s income would no longer be considered for eligibility.
• Requires public release of annual NLDAC report.

Helping End the Renal Organ Shortage (HEROS) Act

• Provides a $50,000 refundable federal tax credit over a period of five years for non-directed living kidney donors.

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And here's one more, from the Coalition to Modify NOTA

Guns and gun control

 In the U.S., gun sales are both a protected transaction and a repugnant one. The right to bear arms is protected by the 2nd Amendment to the Constitution, but as school shootings and other mass casualty attacks on innocents have become a staple of the news, there have been periodic attempts to curb sales, particularly of automatic weapons.  The state of Washington is the latest to ban the sale of certain particular automatic weapons, which are legally available in other states, and already very widely distributed.

The NYT has the story:

Selling AR-15-Style Rifles Is Now Banned in 9 States  By Mike Baker and Nicholas Bogel-Burroughs

"Washington State approved a package of gun control measures on Tuesday that includes a ban on the sale of military-style semiautomatic weapons, making it the ninth state to join efforts to prevent the distribution of AR-15s and other powerful rifles often used in mass shootings.

"The new laws put Washington in the ranks of states with the strongest gun control measures in the nation. They include a 10-day waiting period on gun purchases, gun safety training requirements and a provision allowing the state attorney general and consumers to sue gun manufacturers or dealers under public nuisance laws if they negligently allow their guns to fall into the hands of minors or “dangerous individuals.”

"Gun rights proponents swiftly filed a lawsuit to challenge the semiautomatic rifle ban, saying it infringed on Second Amendment rights.

"Washington is among a series of states, largely led by Democrats, that have advanced gun legislation this year as the nation continues to grapple with repeated mass shootings. Republicans have moved in the opposite direction, with lawmakers in several states introducing legislation to expand the ability to carry concealed weapons without a permit and eliminate such things as gun-free zones, background checks and red-flag laws, which allow the removal of guns from people deemed to be at high risk of violence or self-harm.

...

"All of the bans currently in place allow people to keep weapons previously purchased, but states vary on how those so-called legacy weapons are regulated, according to the Giffords Law Center to Prevent Gun Violence."

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Earlier:

Sunday, April 16, 2023

The (American) market for assault rifles

More anti-gay legislation in Uganda

 The NY Times has the story about new anti-gay legislation awaiting signature by Uganda's president:

We Will Hunt You’: Ugandans Flee Ahead of Harsh Anti-Gay Law. The bill, passed last month, calls for life in prison for anyone engaging in same-sex relations. President Yoweri Museveni congratulated lawmakers for their “strong stand” against L.G.B.T.Q. people.  By Abdi Latif Dahir

"Uganda’s Parliament passed a sweeping anti-gay bill in late March that threatens punishment as severe as death for some perceived offenses, and calls for life in prison for anyone engaging in same-sex relations.

...

"The bill, which passed 387 to 2, punishes anyone who leases property to gay people and calls for the “rehabilitation” of those convicted of being gay. President Yoweri Museveni, who has commended the bill, sent it back to Parliament on Thursday for “improvement,” his party said in a statement.

"The president congratulated lawmakers and religious leaders on what he called their “strong stand” against L.G.B.T.Q. people. “It is good that you rejected the pressure from the imperials,” he said, a reference to Western countries, in footage released by the public broadcaster. He spoke hours after the European Parliament denounced the bill.

"The legislation follows a groundswell of anti-gay rhetoric that has swept African countries in recent years, including in Ghana, Zambia and Kenya. Last month, lawmakers from more than a dozen African countries gathered in Uganda and promised to introduce or pass measures in their own countries that they said would protect the sanctity of the family and children against “the sin of homosexuality.”

...

"The latest move to target L.G.B.T.Q. people in Uganda has drawn support from local Christian and Muslim groups, and for years the financial and logistical backing o"f some conservative evangelical groups in the United States." 

The (American) market for assault rifles

There was a time when Americans thought that rifles were for hunting game, and assault weapons were banned.  That has changed.

The Washington Post has the story:

The gun that divides a nation. The AR-15 thrives in times of tension and tragedy. This is how it came to dominate the marketplace – and loom so large in the American psyche. By Todd C. Frankel, Shawn Boburg, Josh Dawsey, Ashley Parker and Alex Horton 

"The AR-15 wasn’t supposed to be a bestseller.

"The rugged, powerful weapon was originally designed as a soldiers’ rifle in the late 1950s. “An outstanding weapon with phenomenal lethality,” an internal Pentagon report raved. It soon became standard issue for U.S. troops in the Vietnam War, where the weapon earned a new name: the M16.

...

"Today, the AR-15 is the best-selling rifle in the United States, industry figures indicate. About 1 in 20 U.S. adults — or roughly 16 million people — own at least one AR-15, according to polling data from The Washington Post and Ipsos.

...

"One Republican lawmaker, Rep. Barry Moore of Alabama, introduced a bill in February to declare the AR-15 the “National Gun of America.”

"It also has become a stark symbol of the nation’s gun violence epidemic. Ten of the 17 deadliest U.S. mass shootings since 2012 have involved AR-15s.

...

"the U.S. firearms industry came to embrace the gun’s political and cultural significance as a marketing advantage as it grasped for new revenue.

"The shift began after the 2004 expiration of a federal assault weapons ban that had blocked the sales of many semiautomatic rifles. 

...

"Today, the industry estimates that at least 20 million AR-15s are stored and stashed across the country.

"More than 13.7 million of those have been manufactured by U.S. gunmakers just since the Newtown massacre in late 2012"

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NPR puts some history into perspective:

The Nashville school shooting highlights the partisan divide over gun legislation , by Ron Elving, April 1, 2023

"The Stockton schoolyard shooting in 1989

...

"The Stockton story was national news, featured on the cover of Time magazine with the headline "Armed America." Public alarm at Stockton pushed the legislature to be the first to prohibit the sale of assault weapons that year.

"Stockton was still reverberating three years later when California, the home of Republican presidents Richard Nixon and Ronald Reagan, sent two liberal Democrats, both women, to the U.S. Senate It also stocked its legislature and congressional delegation with big Democratic majorities and gave its Electoral College vote to Bill Clinton.

"One of the two women senators elected that year was former San Francisco Mayor Dianne Feinstein, who had first become mayor when her predecessor was shot to death in his office in the 1970s. She had long been outspoken on gun control and brought that commitment to Washington, D.C., becoming one of the principal sponsors of a bill banning assault weapons ban in her first year.

"The Assault Weapons Ban of 1994

"Feinstein and her cosponsors wanted to end the sale or manufacture of 14 categories of semi-automatic assault weapons. They also wanted to go beyond the California ban by outlawing copycat versions of earlier models and high-volume detachable magazines that held more than 10 rounds.

"But the bill did not address the status of an estimated one million assault weapons nationwide. "Essentially what this legislation does is create a freeze," she said. She lamented the resistance that rarely produced actual arguments among her colleagues. She said had never realized "the power of the NRA in this town."

...

"There were literally hundreds of exceptions included in the final version, distressing many of the bill's supporters. But getting the ban into the crime package to be passed in that Congress (with billions in new police funding) required many compromises. Ultimately, to get to a majority, Feinstein would have to accept a sunset provision by which her restrictions would need reenactment after 10 years.

...

"So when the 10-year expiration date on Feinstein's bill arrived in 2004, Democrats were no longer the majority party in Congress and all attempts to extend the 1994 ban were unavailing.

...

"The Sandy Hook Test in 2012

The next time serious energy developed behind renewing the ban was in the winter of 2012-2013. Barack Obama had just been reelected president, and the Senate was still in Democratic hands.

"Just as important, the effort to address the gun issue had been given an enormous boost by a new and more horrific tragedy.

"On Dec. 12, 2012, Adam Lanza, 20 — described by counselors as fascinated with mass shootings — killed his mother and took guns she had legally purchased to a Sandy Hook Elementary School in Newtown, Conn.

"There he shot dead 20 children, ages 6 and 7. He also killed six adults on the school staff. Then he killed himself.

"The national shock at the time is hard to appreciate a decade later, as there have been so many like it. 

...

"But the 113th Congress came and went in 2013 and 2014 without passing notable gun legislation. A compromise measure on background checks, offered by West Virginia Democrat Joe Manchin and Pennsylvania Republican Pat Toomey, got 54 votes in the Senate but needed 60.

"As for prospects for reviving gun legislation in the current Congress, the situation looks much as it did a decade ago. The 118th Congress has a Senate where Democrats have a nominal majority that depends on the cooperation of several independents. Feinstein is still in the Senate, the longest-serving incumbent Democrat, but planning to retire next year.

"The current House, like that of a decade ago, has a Republican majority led by a speaker whose power depends on placating a hardcore group known as the House Freedom Caucus."

Donate blood or organs to pay a traffic fine or shorten a prison term?

I spend a lot of my time thinking and writing about repugnant transactions and controversial markets, and some of that intersects with my work on blood and organ donation and transplantation (particularly on the controversial issue of compensation for donors, and how that might intersect with varieties of coercion). But today's post is about two proposals that mix all these things together. (My guess is that many people will find them differently repugnant: think of them as a quick test of your own views.)

In Argentina, a municipal judge proposes blood donation to pay traffic fines, and in Massachusetts several legislators co-sponsor a bill to allow bone marrow (blood stem cell) donation or organ donation to reduce prison sentences.

First, blood donation and traffic fines:

 Mario Macis points me to this story in La Nacion, about a city in the Argentine province of Salta:

En una ciudad de Salta las multas de tránsito se pueden pagar con una donación de sangre  [In a city of Salta, traffic fines can be paid with a blood donation]  (English from Google Translate)

"In the city of Tartagal, Salta, it is possible to pay a traffic ticket with a blood donation . The measure, taken two months ago, generates both support and questioning.

...

"The judge of the Court of Misdemeanors of the Municipality of Tartagal, Farid Obeid , proposed in a ruling last August that those who had traffic fines could pay them with their own blood donation or from third parties on behalf of the offenders.

"It was then determined that donations be made in hospitals, voluntarily and only once; that is to say that repeat offenders cannot opt ​​for blood donation.

...

"The ruling received support and criticism, the latter basically from the health sector. Oscar Torres, president of the Argentine Association of Hemotherapy, Immunohematology and Cellular Therapy , sent a letter to the Deliberative Council of Tartagal indicating that the measure removes the "spirit of solidarity and altruism from blood donation" 

Here's a related story about the ongoing debate (also using Google translate):

Controversy over an unusual municipal project: they claim that fines can be paid with blood. "This controversial project was presented to the Deliberative Council of Tartagal, and criticism has already begun"

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And here's the new bill proposed in Massachusetts (don't hold your breath waiting for it to be passed into law). It's in English, so the phrase about the necessary "amount of bone marrow and organ(s) donated to earn one’s sentence to be commuted" isn't a translation error; I think it's just awkward (i.e. not meant to be chilling). (But the discussion of donated "organ(s)" makes me think of Kazuo Ishiguro's novel "Never Let Me Go"). 

Bill HD.3822, 193rd (Current), An Act to establish the Massachusetts incarcerated individual bone marrow and organ donation program

"Section 170. (a) The Commissioner of the Department of Corrections shall establish a Bone Marrow and Organ Donation Program within the Department of Correction and a Bone Marrow and Organ Donation Committee. The Bone Marrow and Organ Donation Program shall allow eligible incarcerated individuals to gain not less than 60 and not more than 365 day reduction in the length of their committed sentence in Department of Corrections facilities, or House of Correction facilities if they are serving a Department of Correction sentence in a House of Corrections facility, on the condition that the incarcerated individual has donated bone marrow or organ(s). 

...

"The Bone Marrow and Organ Donation Committee shall also be responsible for promulgating standards of eligibility for incarcerated individuals to participate and the amount of bone marrow and organ(s) donated to earn one’s sentence to be commuted. Annual reports including actual amounts of bone marrow and organ(s) donated, and the estimated life-savings associated with said donations, are to be filed with the Executive and Legislative branches of the Commonwealth. All costs associated with the Bone Marrow and Organ Donation Program will be done by the benefiting institutions of the program and their affiliates-not by the Department of Correction. There shall be no commissions or monetary payments to be made to the Department of Correction for bone marrow donated by incarcerated individuals."

Simultaneous HT to Ron Shorrer, Kim Krawiec, Akhil Vohra