Uniform Anatomical Gift Act (UAGA) & Uniform Determination of Death Act (UDDA)
At a glance
Revocation of FPA after death
No
32.1-291.8(A)
UAGA good faith immunity
Yes
32.1-291.18
Coroner / ME role in UAGA
Yes
OPO must obtain ME release
Yes
32.1-291.22 and 32.1-291.23
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)
32.1-291.2 (Locate "Anatomical gift")
Is revocation of FPA after death allowed?
No
32.1-291.8(A)
Does the UAGA include a good faith immunity clause?
Yes
32.1-291.18
Does the UAGA give instructions for the coroner / Medical Examiner role?
Yes
Must the OPO obtain release from the coroner / Medical Examiner?
Yes
32.1-291.22 and 32.1-291.23
Determination of Death
Types of death referenced in the UDDA
Death by Respiratory and Circulatory Criteria
Death by Neurological Criteria (Brain Death)
Deaths which must be pronounced by a physician
For Neurological Criteria (Brain 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
In Virginia, a minor can make an anatomical gift if they are emancipated, at least 15 years and 6 months old, and eligible for a driver’s license. A parent could also make an anatomical gift on behalf of an unemancipated minor. If an emancipated minor donor dies, a parent could revoke or change the minor’s anatomical gift (even if the minor signed a refusal). (Section 32.1-291.4 and Section 32.1-291.8(g)-(h))
Unique Nuances to Note
Virginia places guardians of the persons above the spouse in the donation decision maker hierarchy. The order is 1. agent 2. guardian 3. spouse 4. adult children 5 parents 6. adult siblings 7. adult grandchildren 8. grandparents 9. adult with special care/concern 10. ther person with authority to dispose of the body. (Section 32.1-291.9)
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
Under Virginia law, nurse practitioners, who has completed at least three years of full time clinical experiences, are also allowed to declare death based on respiratory and circulatory death besides physicians. Autonomous nurse practitioners are authorized to practice without a practice agreement under the subsection I of 54.1-2957.(https://law.lis.virginia.gov/vacode/54.1-2957/)
Other nurses may be able to declare death in certain situations when it is anticipated and a physician or nurse practitioner is not available.
Virginia law requires that brain death declaration must be be made by a physician who is board-eligible or board certified in neurology, neurosurgery, or critical care medicine.