Legislative

There are two major pieces of legislation that regulate organ and tissue donation in the United States: the Uniform Anatomical Gift Act (UAGA) and the National Organ Transplant Act (NOTA).

In addition to these laws that govern donation and transplantation, the Patient Self-Determination Act of 1991 encourages the use of advance directives. Advance directives include living wills, durable powers of attorney for health care, and advanced care medical directives. There is a federal Congressional Organ and Tissue Donation and Transplanation Caucus.  Rep. Jim Costa, D-CA 20th is the current Chair.  For a complete list of Members, please click here.  

AOPO advocates for many issues that affect organ donation, and donor directives are a top priority. AOPO believes all state laws should recognize an individual’s right to make an anatomical gift, and affirms that all participants in the donation process must comply with the directive legislation in their state. The National Association of Attorneys General recently passed a resolution “in support of respecting and upholding the decisions made by persons who elect to be organ, eye, and tissue donors.” To read this resolution, click here.

UAGA

The Uniform Anatomical Gift Act (UAGA) was originally enacted in 1968, and was the first law governing organ and tissue donation in the United States. Prior to its passage, organ donation was handled on a state-by-state basis and systems varied significantly across the country. This important law was promptly adopted by all 50 states. The purpose of the 1968 UAGA was to increase the number of available organs for transplant by making it easier for people to make anatomical gifts. In 1972, the UAGA took this initiative further by mandating that uniform donor cards be recognized as a legally binding document in all 50 states. The Revised Uniform Anatomical Gift Act (R-UAGA), intended to strengthen the donor’s decision to make an anatomical gift, passed in 1987.

In 2006, the UAGA was again revised to provide uniformity in state laws regarding organ and tissue donation. Although every state had previously enacted either the 1968 or 1987 version of the law, there were still variances among states. Additionally, there were huge strides in the technology and practice of donation and transplantation since the last revision. The 2006 UAGA reconciles these differences, strengthens the lifetime decision of a person making an anatomical gift, and clarifies the list of people who can make a donation decision on behalf of a person who has died.

For more information on the UAGA, including a summary of the bill and the enactment status of the 2006 Revised UAGA, please click here. 

NOTA

The National Organ Transplant Act (NOTA) originally passed in 1984 and was amended in 1988 and 1990. Representative Al Gore and Senator Orrin Hatch were the two main sponsors of the legislation. NOTA established the Organ Procurement and Transplantation Network (OPTN), the Task Force on Organ Transplantation and the Scientific Registry of Transplant Recipients (SRTR). NOTA also outlawed the sale of human organs. The OPTN is responsible for maintaining the national transplant waiting list and overseeing the organ allocation process. SRTR provides reports and data on solid organ transplantation in order to increase efficiencies and ensure that the process is as fair as possible.

NOTA also outlined the early establishment of qualified OPOs. The Centers for Medicare and Medicaid Services (CMS) issued the first conditions for coverage on May 2, 1996. The final rule, CMS-3064-F, was then published on May 31, 2006. It became effective on July 31, 2006 (42 CFR Parts §§486.301-348, et al). These guidelines are currently under review by CMS. AOPO expects the final rule for OPO recertification to place a heavier emphasis on quality.