Uniform Anatomical Gift Act

The Uniform Anatomical Gift Act (UAGA), and its periodic revisions, is one of the Uniform Acts drafted by the National Conference of Commissioners on Uniform State Laws (NCCUSL), also known as the Uniform Law Commission (ULC), in the United States with the intention of harmonizing state laws between the states.[1][2][3][4]

UAGA governs organ donations for the purpose of transplantation.[4][2] The Act permits any adult to become an organ donor.[5] It also governs the making of anatomical gifts of one's cadaver to be dissected in the study of medicine.[4] The law prescribes the forms by which such gifts can be made.[4][3][2][1] It also provides that in the absence of such a document, a surviving spouse, or if there is no spouse, a list of specific relatives in order of preference, can make the gift.[4][2] It also seeks to limit the liability of health care providers who act on good faith representations that a deceased patient meant to make an anatomical gift.[4][2] The act also prohibits trafficking and trafficking in human organs for profit from donations for transplant or therapy.[6][7]

The UAGA provides a template for the legislation to adjust public policy and align it with developments in medical practice.[4] Some states have their own version of the UAGA which is an updated version of the Uniform laws already enacted throughout the United States.[8][9]

History

There were three versions of the Uniform Anatomical Gift Act that were enacted; the first was the UAGA of 1968, which was followed up with revisions in 1987. The most recent version was created in 2006.[4][2] The Uniform Anatomical Gift Act has been established in some form, in every state and the District of Colombia (D.C.), as of 2017.[8][5][2]

The law has been revised to make the process of making an anatomical gift more streamlined, and to promote organ donation to citizens in order to address the high demand for donated organs for transplantation.[2] The demand for donated organs is extremely high due to the fact that a large number of people die while waiting for an organ transplant in the United States.[6][4] As of 2016, there were less organ donors registered than the amount of people that are in need of an organ or tissue transplant.[6]

Formerly, anatomical gifts had to be executed with testamentary formalities, including the creation of a written document with two witnesses; the latest version of the statute eliminates the requirement of the witnesses.[3] Medical examiners and medical professionals who cared for a patient upon their death, previously were permitted to remove a part of a body if there was no known next of kin, or if the body was unidentified.[6][2] This change is to encourage the practice of allowing an anatomical gift to be made by a notation on a driver's license.[6][4]

The Uniform Anatomical Gift Act of 1968

The first Uniform Anatomical Gift Act was created after the first successful heart transplant in 1967; the operation was performed by Dr. Christiaan Barnard.[4] In 1968, Congress approved of the UAGA and recommended that all states adopt it.[10] The Act was the first legislation enacted by all states in United States to address the donation of organs, tissues, and eyes as gifts to someone who may be in need of an organ for survival.[3][4] The UAGA was drafted in order to increase organ and blood supplies and donation and to protect patients in the United States.[10] It replaced numerous state laws concerning transplantation and laws lacking a uniform procedure of organ donation and an inadequate process of becoming a donor.[10]

All states adopted the original version of the law.[3]

The Uniform Anatomical Gift Act of 1987

Revisions from UAGA 1968

In 1987, the Uniform Anatomical Gift Act of 1968 was revised so that there was a uniform manner of obtaining consent from individuals.[10][4] At this time, every state enacted at least some part of UAGA.[10] The provisions of the UAGA of 1968 would be to ban the purchase and sale of body parts, facilitate the simplified process of obtaining authorization to retrieve organs, and ensures that medical staff establish procedures and guidelines to identify organ donors while under hospital care.[11] The Act also characterized a body part or organ as property because of the ability of a living individual to gift parts of their body to another individual, or an individual of their choice.[1][10] Another major statement that this revised version of UAGA made was that a coroner's investigation or an autopsy could not be obstructed by an individual's wish for organ donation.[10] The 1987 UAGA regulated organs for the purposes of transplantation or therapy.[11] In addition, the individual's wishes to donate were prioritized over family or next of kin's wishes. Hospitals were authorized to retrieve organs if an individual was found to have documentation of consenting.[11]

The Act's revisions were enacted by 26 states: Alabama, Arizona, Arkansas, California, Hawaii, Idaho, Indiana, Iowa, Minnesota, Montana, Nevada, New Hampshire, New Mexico, North Dakota, Oregon, Rhode Island, the U.S. Virgin Islands, Utah, Virginia, Washington, and Wisconsin.[1]

The Uniform Anatomical Gift Act of 2006

Summary

In 2006, The Uniform Anatomical Gift Act was revised with the three main goals of motivating more of the population to make anatomical gifts, making honoring an individual's wishes to donate a priority, and maintaining the current organ donation and transplantation system in the United States.[6] It also has the purpose of setting rules and guidelines for determining the purposes that one had for choosing to make a gift as well as the purpose of the gift of an organ, eye, or tissue itself.[4] It also was revised to accommodate the developments in medicine and science regarding organ donation and transplantation, as well as the regulations of donation and transplantation with the goal of increasing the supply of gifted organs.[6][4] The Uniform Anatomical Gift Act of 2006 also was revised in order to make the laws governing anatomical gifts more uniform between states that had enacted and continued to enforce the UAGA of 1968 and ones that had enacted the revised UAGA of 1987, leading to more consistency.[4]

Important Revisions

The UAGA of 2006 allows for individuals to consent to organ donation by expressing their wish when obtaining a driver's license, verbal expression, by writing it in a will or other advance directive, or in any other manner that one may decide upon.[4][2] This has simplified the consent process.[2][4] This is also known as "opting in" to organ donation, meaning that unless explicitly stated, it is assumed that upon death one wishes to keep their organs instead of donate them.[2] In some states, one may register to become an organ donor online on a state's Donor Registry website and an individual is permitted to choose which organs they wish to donate by checking boxes.[6] An important addition to the UAGA of 2006 was the strengthening of certain language regarding one's right to make a decision for themselves pertaining to consent of organ donation, making it harder for others to try to nullify one's wish to consent after their death.[7][4] The only exception that an individual's consent to donate may be overridden, is in the case of the death of a minor when parents or guardians may override the minor's consent.[7][4] Language in the act is also made more clear so that one cannot revoke an anatomical gift as the donor's decision is final.[7][4] This revised UAGA additionally created legislation allowing certain people to make an anatomical gift to another person while the donating individual is still alive.[4] It is stated that it's the duty of law enforcement officers, firefighters, paramedics, and other emergency personnel to search for the records of donor consent upon death.[6] Another significant addition to the Uniform Anatomical Gift Act of 2006 is the rule of making transplantation or therapy prioritized over research or education with an anatomical gift, when a donor's wishes are unclearly stated in documentation.[4]

The Uniform Anatomical Gift Act of 2006 clarifies words written in the law that formerly were ambiguous and confusing such as: anatomical gift, record, refusal, guardian, prospective donor, reasonably available, and disinterested witness.[7][6]

The UAGA revision of 2006 makes it a felony punishable by a fine or prison to buy or sell body parts, as well as purposefully hiding, falsifying, defacing, or destroying organ donor documentation of another.[6]

Many states have drafted and enacted their own updated versions of UAGA based on the revisions of 2006.[8][9]

Legislation Status of UAGA in the U.S.

In the United States, all states have enacted some version of UAGA.[8][9] States have the authority to use the Uniform Anatomical Gift Acts as a template to put additional revisions into law depending on what best fits the state's needs.[8]

Uniform Anatomical Gift Act (UAGA) Legislation of U.S. States and Territories[8][9][1][3][4][6]
U.S. State or Territory UAGA Legislation Version
Alabama 2006
Alaska 2006
Arizona 2006
Arkansas 2006
California 2006
Colorado 2006
Connecticut 2010
Delaware 2015
District of Colombia (D.C.) 1968
Florida 2008
Georgia 2006
Hawaii 2006
Idaho 2006
Illinois 2006
Indiana 2006
Iowa 2006
Kansas 2006
Kentucky 2006
Louisiana 2006
Maine 2006
Maryland 2012
Massachusetts 2006
Michigan 2008
Minnesota 2006
Mississippi 2006
Missouri 2006
Montana 2006
Nebraska 2006
Nevada 2006
New Hampshire 2006
New Jersey 2006
New Mexico 2006
New York 1987
North Carolina 2006
North Dakota 2006
Ohio 2006
Oklahoma 2006
Oregon 2013
Pennsylvania 1987
Puerto Rico 2006
Rhode Island 2006
South Carolina 2006
South Dakota 2006
Tennessee 2006
Texas 2006
U.S. Virgin Islands 2006
Utah 2006
Vermont 2006
Virginia 2006
Washington 2006
West Virginia 2008
Wisconsin 2006
Wyoming 2006

Ethical Concerns

UAGA does not specify regulations for organ donation by a prisoner or prohibit an inmate from donating their body or an organ.[5] Christian Longo, a convicted murderer, has played a key role in rousing public debate regarding the rights of the incarcerated to become organ donors.

The retrieval of gametes from the deceased have been the subject of controversy because of the highly publicized court case In re Matter of Daniel Thomas Christy in Iowa, regarding the right to retrieve reproductive cells (Posthumous sperm retrieval) from a deceased spouse or partner.[12] The argument against the retrieval of post mortem gametes in this case was that UAGA stated the purposes of donation were for transplantation, therapy, research, or education.[12]

Since the Uniform Anatomical Gift Act was put into effect in all states, there still has been a donor shortage in the United States.[4][10][2][11]

See also

References

  1. 1 2 3 4 5 The National Conference of Commissioners on Uniform State Laws (2017). "Anatomical Gift Act (1987)". Uniform Law Commission. Retrieved April 3, 2017.
  2. 1 2 3 4 5 6 7 8 9 10 11 12 13 Angelo, Mark; Lefler, Daniel Simon (2016). "Applied ethics in health care administration: A case study of organ donation in an unidentified person". Journal of Hospital Administration. 5 (4): 44–48. doi:10.5430/jha.v5n4p44 – via Sciedu.
  3. 1 2 3 4 5 6 The National Conference of Commissioners on Uniform State Laws (2017). "Anatomical Gift (1968)". Uniform Law Commission. Retrieved April 3, 2017.
  4. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 The National Conference of Commissioners on Uniform State Laws (2017). "Anatomical Gift Act (2006)". Uniform Law Commission. Retrieved April 3, 2017.
  5. 1 2 3 Seals Bersinger, Amanda; Milot, Lisa (2016). "Posthumous Organ Donation as Prisoner Agency and Rehabilitation". DePaul Law Review. 65 (4): 1194–1234.
  6. 1 2 3 4 5 6 7 8 9 10 11 12 Kielhorn, Kristi (2007–2008). "Giving life after death: the 2006 revision of the uniform anatomical gift act". Drake Law Review. 56 (3): 809–828 – via HeinOnline.
  7. 1 2 3 4 5 Nwabueze, Remigius (2008). "Donated Organs, Property Rights and the Remedial Quagmire". Medical Law Review. Oxford University Press. 16 (2): 1–18.
  8. 1 2 3 4 5 6 Verheijde, Joseph; Rady, Mohamed; McGregor, Joan (2007). "The United States Revised Uniform Anatomical Gift Act (2006): New challenges to balancing patient rights and physician responsibilities". Philosophy, Ethics, and Humanities in Medicine. 2 – via NCBI.
  9. 1 2 3 4 "State Organ Donor Legislation". OrganDonor.Gov. U.S. Department of Health and Human Services. 2011. Retrieved April 3, 2017.
  10. 1 2 3 4 5 6 7 8 Wilding Knope, Denay (2009–2010). "Over my dead body: how the albrecht decisions complicate the constitutional dilemma of due process & the dead". Toledo Law Review. 41: 169–211 – via HeinOnline.
  11. 1 2 3 4 McIntosh, Ann (1990). "Regulating the "Gift of Life"-The 1987 Uniform Anatomical Gift Act". Washington Law Review. 65: 171–188 – via HeinOnline.
  12. 1 2 Spielman, Bethany (2009). "Pushing the dead into the next reproductive frontier: post mortem gamete retrieval under the uniform anatomical gift act". Journal of Law, Medicine & Ethics. 37 (2): 331–343.
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