The Uniform Anatomical Gift Act (UAGA) is the model law that governs organ and tissue donation in the United States. First drafted in 1968, it provides the legal framework for how people can authorize the donation of their body or body parts after death, who can make that decision if they haven’t, and how hospitals and procurement organizations must handle the process. Every U.S. state has adopted some version of it.
What the Act Actually Does
At its core, the UAGA establishes that every adult has the legal right to donate organs and tissues at or near death. It spells out how that choice can be made, recorded, and carried out. Donations under the Act can be used for transplantation, therapy, research, or education.
The law also creates rules for situations where a person dies without having recorded a preference. In those cases, it identifies a ranked list of family members and other individuals who can authorize donation on the deceased person’s behalf. And it sets ground rules for hospitals, organ procurement organizations (OPOs), and medical examiners so that the process moves quickly enough for organs to remain viable.
How the Law Has Changed Over Time
The UAGA has gone through three major versions: 1968, 1987, and 2006. Each revision was designed to increase the supply of donated organs and clarify who holds decision-making authority.
The original 1968 version allowed adults to donate body parts, but required a written, signed document with two witnesses. It also left a gray area around whether a donor’s family could override the donor’s wishes after death. The 1987 revision dropped the two-witness requirement, brought the law in line with the federal ban on selling organs, and emphasized that an individual’s documented choice to donate cannot be revoked by someone else.
The most recent version, from 2006, went further. It strengthened the principle that a donor’s recorded decision is final, with no family override permitted. It expanded the list of people who can consent on behalf of someone who never documented a preference. It removed a provision that had allowed medical examiners and coroners to independently authorize organ removal for transplantation. And it established a presumption in favor of donation: if someone hasn’t made their wishes known either way, the law leans toward allowing authorized family members to consent. If a person specifically does not want to donate, they must record that refusal in a signed document.
How Donor Decisions Are Recorded
You can make an anatomical gift in several straightforward ways. The most common is checking a box when you get or renew your driver’s license or state ID, which authorizes a statement or symbol to be printed on the card. You can also register through your state’s donor registry, typically maintained by the secretary of state or a similar office. Registering is legally effective without witnesses.
Once you’ve registered or marked your license, that decision carries full legal authority. No additional consent from family members is required. Under the 2006 version of the Act, your documented choice is binding, and other people are barred from changing, amending, or revoking it unless you’ve left an express, contrary indication.
Revoking or Changing Your Decision
If you’ve previously registered as a donor and change your mind, you can revoke the gift. The specific steps vary by state, but the law generally recognizes several methods: delivering a signed written statement to the organization that holds your registration, making an oral statement in the presence of two people, communicating your wishes to a physician during a terminal illness or injury, or carrying a signed card or document on your person. For gifts recorded on a driver’s license, some states require written notice to the motor vehicle agency. You can also destroy or cancel the original document and all copies.
Who Decides When There’s No Recorded Wish
When someone dies without having documented a donation preference, the Act provides a priority list of people who can authorize an anatomical gift. The order is:
- Agent of the deceased (someone with a healthcare power of attorney)
- Spouse or domestic partner
- Adult children
- Parents
- Adult siblings
- Adult grandchildren
- Grandparents
- An adult who exhibited special care and concern for the deceased
- Guardian or conservator
- Coroner, medical examiner, or hospital administrator
The person highest on the list who is reasonably available at or near the time of death holds the authority. This means a spouse’s authorization overrides a sibling’s objection, and a parent’s decision takes precedence over a grandparent’s.
Rules for Hospitals and Procurement Organizations
The 2006 Act requires hospitals to notify an organ procurement organization whenever a patient’s death is imminent or has occurred. OPOs are the federally designated nonprofits responsible for identifying potential donors, requesting consent from families when needed, recovering organs, and coordinating with transplant hospitals to match organs with recipients.
One of the more significant provisions requires that life support already being administered to a patient must be continued after the OPO is notified, at least until it can be determined whether the patient’s organs are medically suitable for transplantation. The Act also creates a default rule that measures necessary to keep organs viable for transplant cannot be withheld or withdrawn. These provisions are aimed at preserving the window for donation, since organs deteriorate rapidly once blood flow stops.
Coordination With Medical Examiners
When a death falls under the jurisdiction of a medical examiner or coroner, such as in cases involving accidents, homicides, or unexplained causes, procurement organizations must coordinate carefully. Written agreements or memorandums of understanding between the two parties guide the process. The medical examiner has the option to perform an external examination before any procurement takes place. If the procurement team discovers unexpected abnormalities during organ recovery, they are required to notify the medical examiner immediately and wait for further direction. The goal is to balance the time-sensitive nature of organ donation with the need to preserve evidence for death investigations.
Liability Protections
The Act provides broad legal immunity to anyone who participates in the donation process in good faith. A person who acts in accordance with the law is not liable for civil damages and cannot face criminal prosecution, as long as the legal prerequisites for the gift were met at the time and place it was made. This protection extends to donors, their estates, healthcare providers, and procurement staff.
The immunity has limits. It does not cover acts that are intentional, willfully negligent, or done with reckless disregard. When determining who has the authority to authorize a donation, “good faith” means making a reasonable effort to locate and contact the highest-priority family member who is available at or near the time of death. The law also allows people involved in the process to rely on someone’s stated relationship to the donor unless they have reason to believe the claim is false.