Uniform Anatomical Gift Act (UAGA) & Uniform Determination of Death Act (UDDA)
At a glance
Revocation of FPA after death
No
23-06.6-07 (1)
UAGA good faith immunity
Yes
23-06.6-17
Coroner / ME role in UAGA
Yes
OPO must obtain ME release
Yes
23-06.6-21 and 23-06.6-22
Nurse DCD pronouncement
Yes
UDDA good faith immunity
Unknown
Anatomical Gift Act
When does FPA take effect?
After death.
(The type of death is not specified, as it is determined under the UDDA)
23-06.6-01 (3)
Is revocation of FPA after death allowed?
No
23-06.6-07 (1)
Does the UAGA include a good faith immunity clause?
Yes
23-06.6-17
Does the UAGA give instructions for the coroner / Medical Examiner role?
Yes
Must the OPO obtain release from the coroner / Medical Examiner?
Yes
23-06.6-21 and 23-06.6-22
Determination of Death
Types of death referenced in the UDDA
Death by Circulatory and Respiratory Criteria.
Death by Neurological Criteria (Brain Death).
Deaths which must be pronounced by a physician
No specific roles are specified for pronouncement of either type of death.
How many brain death declarations are required?
One brain death declaration is needed.
Could nurse pronouncement in DCD be possible?
Yes
Does the UDDA include a good faith immunity clause?
Unknown
Pediatric Nuances & Insights
A minor who is emancipated or at least 14 years old and legally eligible to apply for a driver’s license may register as an organ donor. If the minor is not emancipated, a parent or legal guardian may make the anatomical gift decision on the minor’s behalf. (Section 23-06.6)
State Education Initiatives, Recommendations & Requirements
North Dakota law requires every school district’s driver education curriculum to include information on how students can register as organ donors when they obtain a driver’s license
Unique Nuances to Note
The state of North Dakota has very detailed coroner/Medical Examiner (ME) cooperation requirements. If the coroner/ME thinks recovery may interfere with determining cause or manner of death, they need to consult with the procurement organization first before denying recovery. After consultation, they could allow recovery o deny it only if the part may be involved in determining cause or manner of death. (Section 23-06.6-22(5) and 23-06.6-22(6))
If the recovery is denied, the coroner/ME needed to explain the specific reason in writing including them in their records and provide the explanation to the procurement organization. If the recovery is allowed, the procurement organization could be required to provide the coroner/ME with documentation including condition of part, biopsy, photograph and other information that would be helpful for the post mortem exam. (Section 23-06.6-22(7) and 23-06.6-22(8))
Healthcare is managed state by state. Each state has its own version of the Uniform Anatomical Gift Act (UAGA), which outlines the rules around the gift of organs, eyes and tissues, as well as its own version of the Uniform Determination (or Declaration) of Death Act (UDDA).
In general, the majority of states have adopted the Revised UAGA, which emphasizes the legally binding nature of First Person Authorization (FPA) for donation. In most states FPA takes effect after death, at which point the decision cannot be revoked or amended. One must then review how that state determines a person to be dead under its UDDA. The exception is minors, where in most instances a parent can change the minor’s decision.
There can be nuances within state laws that differ from state to state. An effort has been made to highlight some of them here, however this reference is not all inclusive. It is highly advised to read each state’s UAGA and UDDA thoroughly for clarity.
This legislative reference guide is not intended to serve as legal advice. For further detailed questions, please contact your local OPO. For any inaccuracies or corrections, please contact The Alliance at info@organdonationalliance.org.
Other Comments
North Dakota’s UDDA emphasize that for both circulatory/respiratory and neurological death, determination must be made according to accepted medical standards. (Section 23-06.3-01)
If death is imminent, the physician must try to notify the next of kin and document those efforts. (Section 23-06.3-02)