Esbensen KL, DeCamp M, Crigger EJ, Snyder Sulmasy L; ACP Ethics, Professionalism and Human Rights Committee; Esbensen KL. Ethical Issues in Organ Transplantation: A Position Paper From the American College of Physicians. Ann Intern Med. 2025 Oct 28. doi: 10.7326/ANNALS-25-01738. Epub ahead of print. PMID: 41144970.
First-Person Authorization
Resource Hub
This resource hub is designed to support donation professionals by showcasing current FPA practices in DCD and brain death cases nationwide. It offers effective strategies and practical tools to promote greater consistency and alignment throughout the donation process.
Born out of collaborative discussions within The Alliance’s National Donation Leadership Council, this initiative seeks to promote greater consistency, transparency, and alignment across the field. Through thoughtful analysis of how FPA is implemented in practice, this new resource hub is designed to be a dynamic, go-to destination for frontline teams, clinical leaders, and administrators, offering effective strategies, practical tools, and policy frameworks to support and strengthen FPA efforts across the continuum.
To help anchor this work in shared values and purpose, the organizing committee has also developed a Community Consensus Statement that reflects our collective position on FPA. This statement reinforces why we exhaust every effort to honor donor intent and illustrates our commitment to ethical integrity and public trust throughout the donation process.
Community Consensus Statement
A common and legally binding way to establish donor intent is through the written authorization of an anatomical gift. This is commonly referred to as First Person Authorization (FPA).
Written authorization of an anatomical gift may be designated in a will or health care directive, on a driver’s license or identification card, or on a state or national registry. As such, after death is declared by either neurologic or circulatory criteria, if the patient provided First Person Authorization that was not revoked by that individual, that First Person Authorization is a legal and binding decision.
Local organ procurement organizations inform families or the patient’s authorized representatives of their loved one’s decision, and together with hospital care teams, support them throughout the donation process and beyond. Fulfilling individual donation decisions requires collaboration regarding the timing and communication surrounding the decision to withdraw support measures. This, along with caring for families through the donation process, honors the generosity of individuals and the lifesaving gifts of donation.
In the absence of written First Person Authorization, other expressions of donor intent will be explored with the patient’s authorized representative.
FEATURED WEBINAR
LEGAL & ETHICAL CONSIDERATIONS IN NAVIGATING FIRST-PERSON AUTHORIZATION
On July 17, 2025, The Alliance hosted a discussion focused on the legal definition of First-Person Authorization (FPA) and what constitutes as a true objection to FPA. We explored what the law said about an individual’s right to make a legally binding donation decision, as well as the legal and ethical complexities that arose when donor designation was questioned or retracted. To guide this discussion, we were joined by legal experts Christina Strong and Brendan Parent, who offered their insights into the legal framework of FPA and its broader ethical implications in organ donation and transplantation.
Advancement Learning Series
The Alliance Live & On-Demand Advancement Series offers a diverse lineup of webinars focused on timely, high-impact topics shaping the donation and transplantation community of practice. The sessions highlighted below explore key insights related to First-Person Authorization (FPA), providing valuable guidance to help donation professionals navigate the recovery process more effectively.
FPA Focused Sessions
- Maximizing Community Partnerships: First Person Authorization in DCD
- 2023 AAN Braun Death Updates: Approaches in Aligning Hospital & OPO Policies
- OPO-Hospital Joint Accountability: Exploring Effective Strategies to Address Missed Donation Opportunities
- Matching Family Expectations – Collaboration to Support Timely Donation Conversations
- A Holistic Approach to Donation: Exploring Best Practices to Improve Tissue Authorization Outcomes
- Does Our Messaging Match Our Mission?
- Navigating DCD Cases: Recognizing Missed Opportunities
- Navigating DCD Cases: Fostering Collaborative Partnerships with Palliative Care
- Navigating DCD Cases: First Person Authorization Opposition
- Increased Donation Rates Through Utilization of Critical Care TeleHealth
Live Conversation Series
The Alliance Conversation Series delivers fast-paced, cost-free sessions that highlight effective practices and innovative solutions from across the donation and transplantation community. The FPA-focused discussions featured below bring together multidisciplinary experts to address common challenges in navigating First-Person Authorization (FPA) cases, offering actionable insights and real-time collaboration.
FPA Focused Sessions
- FPA Opposition: Case Studies
- The Power of Words: What’s the Difference?
- Bridging Faiths: Interreligious Dialogues on Organ Donation and Transplantation
- Outreach & Education within the Christian Community
- Outreach to Jewish Families: A Comprehensive Approach
- Outreach & Education within the Muslim Community
Virtual Courses
The Alliance Foundational Perspectives of Organ Donation is an expert-led, interactive course that provides a comprehensive overview of the organ donation process for multidisciplinary healthcare teams, particularly early-career clinicians and OPO professionals. This full-day program covers clinical, legal, and administrative aspects, as well as care team collaboration and family dynamics, equipping frontline providers with a shared understanding to support effective donation practices.
FEATURED CASE REVIEWS
FROM THE FRONTLINE
Case studies serve as valuable shared learning tools that illustrate what drives improved outcomes and enhances overall efficiency across the donation and transplantation continuum. These real-world examples highlight best practices implemented to address common barriers encountered in First-Person Authorization (FPA) cases. Each case study offers practical insights into how organizations have successfully navigated complex scenarios, demonstrating effective application of best practices, communication strategies, and creative solutions.
The Alliance Learning Pathways are on-demand, expert-led courses designed to explore critical topics in donation and transplantation.
Guiding your journey
Donation Authorization Strategies
The dynamics of donation discussions have long been identified as key components to increasing conversion. Join us to hear successful techniques from various OPOs who have cultivated new processes surrounding family care. Elements of each presentation will include staff development and accountability, phone approaches, and family care excellence in the age of a pandemic. If your OPO is taking a closer look at authorization practices, you will find this course most helpful, as it will provide some practical techniques for adjusting to the changing healthcare landscape and family care roles.
Online Resources
Interactive Map
STATE LEGISLATION & DONOR REGISTRIES BY STATE
This interactive map provides state-by-state information on key legislation—such as the Uniform Anatomical Gift Act (UAGA) and Determination of Death laws—as well as links to official donor registries. These laws and registries form the legal and practical foundation that enables individuals to commit to organ and tissue donation. Please note that legislation and linked registry sites may change; use is subject to our Terms and Conditions.
Spotlight Series
TIMELY INSIGHTS DESIGNED BY PRACTICIONERS
The Alliance Spotlight Series is a recurring one-page publication for front-line healthcare professionals, offering quick-takes on critical topics affecting the field of organ donation and transplantation including First-Person Authorization (FPA).
- Honoring First Person Authorization in Donation after Circulatory Death, Part 1: The Legalities
- Honoring First Person Authorization in Donation after Circulatory Death, Part 2: The Ethics
- Honoring First Person Authorization in Donation after Circulatory Death, Part 3: The Practicalities
- The Donation Conversation as a Process
- The Power of Words
Community Resource Toolbox
FPA-FOCUSED TOOLS & RESOURCES
2024
Organ and Tissue Donation – A Family-Centered Approach to Organ and Tissue Donation
Organ and Tissue Donation – A Family-Centered Approach to Organ and Tissue Donation: A guidance document for collaboration between Primary Children’s Hospital and DonorConnect.
Primary Children's Hospital & DonorConnect
2022
The SRTR Task 5 Initiative: Identifying Metrics to Support Informed Decision Making by Critical Audiences
Snyder JJ, Schaffhausen CR, Hart A, Axelrod DA, Dils D, Formica Jr RN, Gaber AO, Hunt HF, Jones J, Mohan S, Patzer RE, Pinney SP, Ratner LE, Slaker D, Stewart D, Stewart Lewis Z, Van Slyck S, Kasiske BL, Hirose R, Israni AK. Stakeholders’ Perspectives on Transplant Metrics: The 2022 Scientific Registry of Transplant Recipients’ Consensus Conference. Am J Transplant. 2023 Jul;23(7):875-890.
2021
Organ Donation Authorization After Brain Death Among Patients Admitted to PICUs in the United States, 2009-2018
Spaulding AB, Zagel AL, Cutler GJ, Brown A, Zier JL. Pediatric Critical Care Medicine: A Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. 2021;22(3):303-311. doi:https://doi.org/10.1097/PCC.0000000000002648
A Message from The FPA Committee
Thank you for visiting The Alliance’s First-Person Authorization (FPA) Resource Page, an initiative designed to examine and advance FPA practices in both Donation after Circulatory Death (DCD) and brain death cases nationwide.
Of important note, this resource is not static – It is intended to evolve over time, shaped by community feedback, real-world experience, and the ongoing needs of the field. As you engage with the content, we encourage you to share your questions, insights, and suggestions through the feedback form.
Thank you for your continued commitment to advancing organ donation and transplantation.
Rondi Gelbard
MD, FACSUAB Hospital
Katie McKee
MPHMayo Clinic
Brendan Parent
JDNYU Langone Health
Judith Pepe
MDHartford Hospital
Christine Radolovic
Gift of Life Donor Program
Michelle Reef
MANATCO
Schawnté Williams-Taylor
RN, MBA, MSML, CPTCS. Williams Taylor Corporation