The United States Revised Uniform Anatomical Gift Act (2006): New challenges to balancing patient rights and physician responsibilities

Abstract

Advance health care directives and informed consent remain the cornerstones of patients' right to self-determination regarding medical care and preferences at the end-of-life. However, the effectiveness and clinical applicability of advance health care directives to decision-making on the use of life support systems at the end-of-life is questionable. The Uniform Anatomical Gift Act (UAGA) has been revised in 2006 to permit the use of life support systems at or near death for the purpose of maximizing procurement opportunities of organs medically suitable for transplantation. Some states have enacted the Revised UAGA (2006) (2006) towards the presumption about how to dispose of one's organs at death can pave the way for an affirmative "duty to donate". There are at least two steps required to resolve these challenges. First, physicians and hospitals must fulfill their responsibilities to educate patients on the new legislations and document their preferences about the use of life support systems for organ donation at the endof-life. Second, a broad based societal discussion must be initiated to decide if the Revised UAGA (2006) infringes on the PSDA and the individual's right of autonomy. The discussion should also address other ethical concerns raised by the Revised UAGA (2006), including the moral stance on 1) the interpretation of the refusal of life support systems as not applicable to organ donation and 2) the disregarding of the diversity of cultural beliefs about end-of-life in a pluralistic society.

Islam and End-of-Life Practices in Organ Donation for Transplantation: New Questions and Serious Sociocultural Consequences

“…The realities of the last four reasons are questionable. In 2006, the Revised UAGA introduced a default rule of initiating measures (and use of life support systems) for preserving transplantable organs before death without prerequisite voluntary consent to donation (Verheijde, Rady & McGregor, 2007a). Also, donating organs from the incipiently dying or the not really dead patients has never been publicly debated to proclaim that such an action is a socially desirable goal on behalf of the general public.…”

A Model for Emergency Department End‐of‐life Communications After Acute Devastating Events—Part II: Moving From Resuscitative to End‐of‐life or Palliative Treatment

“…19 A symbol on the vehicle driver license of a prospective donor may indicate desire to donate organs, especially in states that have adopted the revised 2006 UAGA (Table 3). [20][21][22][23] In states with donor registries, a particular vehicle driver license symbol indicates prior authorization for organ donation whenever possible; moreover, this authorization has legal priority for donation during any subsequent discussions concerning measures for organ preservation with a surrogate for the patient. If a person has not made a document of gift during life, one interpretation of the revised 2006 UAGA presumes intent to donate and expands the list of persons who can consent to organ donation on behalf of that individual.…”

“…If a person prefers not to donate, this must be documented in a signed explicit refusal. 24 Whenever controlled DCD may occur, the revised 2006 UAGA requires that life support systems in place at the end of life continue until a notified organ procurement organization completes evaluation of the prospective donor in an ED or intensive care unit (ICU) for suitability to donate. However, if the prospective donor has no signed refusal of donation, UAGA (revised in 2009 22 ) gives the surrogate authority to resolve with the attending physician any conflict between presumed intent to donate and an advance directive not to use life support systems merely to prolong life.…”

Applied ethics in health care administration: A case study of organ donation in an unidentified person

“…Overall, it is believed that the 2006 revision to the UAGA sought to increase the supply of donated organs in response to an increasing and overwhelming demand. [8] Donation authorization can come from any medical decision maker for the patient, next-of-kin, or, in rare cases, "any other person having the authority to dispose of the decedent's body". [9] In this case, the hospital administration was permitted to dispose of the unclaimed body, and therefore, the hospital administration is given the legal authority to give approval to organ donation.…”