Uniform Anatomical Gift Act (UAGA) & Uniform Determination of Death Act (UDDA)
At a glance
Revocation of FPA after death
Unknown
UAGA good faith immunity
Yes
3620f
Coroner / ME role in UAGA
Unknown
OPO must obtain ME release
Unknown
Nurse DCD pronouncement
Yes
UDDA good faith immunity
Unknown
Anatomical Gift Act
When does FPA take effect?
After death.
3620d. Donors - (a)
Is revocation of FPA after death allowed?
Unknown
Does the UAGA include a good faith immunity clause?
Yes
3620f
Does the UAGA give instructions for the coroner / Medical Examiner role?
Unknown
Must the OPO obtain release from the coroner / Medical Examiner?
Unknown
Determination of Death
Types of death referenced in the UDDA
Death determined by neurological criteria.
Death based on permanent cessation of circulatory and respiratory functions.
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
Individuals must be 18 years or older to make an anatomical gift. Parents or other authorized persons may authorize a donation after a minor’s death if the minor did not express a donation decision. (Section 3620d)
State Education Initiatives, Recommendations & Requirements
The Department of Education must collaborate with the Human Body, Organ and Tissue Disposal Board to coordinate and implement organ donation education programs and include them as part of the public school curriculum. (Section 3620w)
Unique Nuances to Note
Puerto Rico’s decision-maker hierarchy is different from most states. Family members are authorized to make donation decision in a specific order only if the deceased did not leave a clear statement about donation. The hierarchy starts with the deceased’s surviving spouse, provided they were living with the deceased at the time of their death. If there is no surviving spouse, the decision-making responsibility passes to the deceased’s oldest adult children. If there is no oldest adult child, the responsibility then passes to the deceased’s parent or grandparent with whom they lived. If none of that existed, the deceased’s siblings hold the responsibility. (Section 3620d(c))
Unlike most states, Puerto Rico’s donation law establishes a dedicated government body, known as the “Human Bodies, Organs and Tissues Disposition Board”. This Board oversee some aspects of anatomical donations and unclaimed bodies. The Board is defined within the statute itself and plays a role in situations involving unclaimed deceased persons. Fo instances, if a deceased person remains unclaimed after the required search period has ended, the institution must notify the Board, and they will be involved in determining the deceased person’s final disposition and any potential donation opportunities. (Section 3260a and 3620I)
In the case of deceased persons under Commonwealth jurisdiction who undergo an autopsy, Puerto Rico specifically allows pathologists, forensic physicians, ophthalmologists, surgeons and their assistant to recover corneas, organs, glands, tissues and other body parts, provided that this does not interfere with the autopsy or any criminal investigation or change the post mortem appearance of the donor’s body. This is a very detailed forensic autopsy legislation that is written within the statute. (Section 3620f)
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
It is not specified who must declare brain death. In Donation after Circulatory Death cases, nurses could potentially pronounce circulatory death.