Senate Joint Resolution (SJR) 454, agreed to by the 1999 General Assembly, directed the Joint Commission on Health Care (JCHC) to continue its review of organ donation issues in the Commonwealth. Specifically, SJR 454 directed JCHC to study the role of the Virginia Department of Motor Vehicles within the state's overall efforts to promote organ donation. Furthermore, SJR 454 directed JCHC to examine the appropriate level of state oversight of organ procurement organizations (OPOs) serving the Commonwealth, as well as the degree to which the number of OPOs in Virginia may affect organ recovery and allocation.

In November 1998, JCHC staff presented an initial issue brief titled Review of Organ Donation Issues. The issue brief included the following findings:

• organ transplantation is a lifesaving medical procedure;

• the Virginia Transplant Council (VTC), a unit of the Virginia Department of Health, is statutorily-responsible for coordinating organ donation education and awareness activities within the state;

• as organ transplants have become more generally-accepted and successful, the demand for organs has far exceeded the available supply;

• the number of individuals who have died while awaiting a transplant has increased;

• five OPOs have been certified by the United States Health Care Financing Administration (HCFA) to recover human organs within designated geographic regions of Virginia;

• Virginia is served by five organ transplant centers, in addition to a transplant center at a United States Veteran's Administration medical center;

• organ procurement rates in Virginia were below the national average in 1997, based on the number of organs recovered per one million population standard used by HCFA for the certification of OPOs; and

• the organs recovered per one million population standard has been criticized by the General Accounting Office, and organ procurement organizations, for failing to account for differences in organ donation potential in different regions of the United States.

Item 335 (HH) of the 1999 Appropriation Act requires the Department of Medical Assistance Services to assist JCHC in a review of Medicaid coverage and reimbursement policies for organ transplants. The review is required to include consideration of the appropriateness of (i) current Medicaid coverage for organ transplants; (ii) the reimbursement procedures and amounts applicable to organ transplants that are covered; (iii) fiscal impact of any changes in Medicaid policies related to coverage or reimbursement for organ transplants; and (iv) case management by the Department of Medical Assistance Services for transplant recipients.