Real World Impact of Our Acts
50th Anniversary of the Uniform Anatomical Gift Act
On December 3, 1967, in Cape Town, South Africa, Dr. Christiaan Barnard performed the first successful human heart transplant in medical history. Less than a year later, on August 6, 1968, after three years of drafting, the Uniform Law Commission approved the Uniform Anatomical Gift Act (UAGA). These two groundbreaking events would lead to the transformation of the lives of thousands of patients and their families.
Before UAGA was available, American law had fallen so far behind scientific developments that the law threatened to deny Americans the full benefits of the latest medical advances. At the time of the Uniform Act’s approval in 1968, the United States was in desperate need of clarity in the law.
UAGA was a revolutionary act. It stipulated for the first time, that an individual, upon death, could donate his or her organs for medical purposes by signing a simple document before witnesses. As easy as this sounds, the Uniform Act represented a departure from centuries of common-law precedent, which held that a body immediately after death became the property of the next-of-kin. That was a major first step. The Uniform Anatomical Gift Act was subsequently adopted by all 50 states and the District of Columbia.
In following years, new medical technologies dramatically increased the number of transplants and the demand for organs, resulting in a serious shortage. This caused the ULC to revisit the subject, and in 1987, a new revised Uniform Anatomical Gift Act was drafted to help narrow the gap between supply and demand.
The 1987 UAGA simplified the "document of gift" permitting organ donations and dropped the requirement for witnesses to the document. In the absence of such a document, the act expanded the list of people who can act on behalf of a decedent and permit a donation. The 1987 Act was enacted in 26 states.
Uneven adoption of the 1987 UAGA and numerous amendments over the years in each state eliminated uniformity. State and Federal law were no longer in sync. The practice of organ donation had changed significantly since 1987, including a rise in the importance of organ procurement organizations. So the ULC revised the act once again, in 2006.
The 2006 Act increased focus on personal autonomy in the donation process; it simplifies the document of gift and recognizes driver’s license donation forms. It also strengthens an individual’s right not to donate by permitting signed refusals. The 2006 UAGA makes numerous other changes that modernize the Act. The 2006 UAGA has been very successful, having been enacted in 48 states to date. Delaware, Florida, New York, and Pennsylvania are the only states that have not enacted the 2006 version.
Despite the great successes in the field of organ transplantation, a severe organ shortage persists in this country. According to the national registry maintained by the United Network for Organ Sharing (UNOS), there are currently more than 111,000 people waiting for an organ. More than 100 people are added to the nation’s organ transplant waiting list each day – one every 10 minutes. On average, 20 patients die every day while awaiting an organ – one person every 72 minutes.
In “Organ Transplantation and the Uniform Anatomical Gift Act: A Fifty-Year Perspective” (Hastings Center Report 48, no. 2, 2018), Blair Sadler and Alfred Sadler, both advisors to the original UAGA drafting committee, write: “During the past fifty years, the UAGA has provided a sound and stable platform on which to base an effective nationwide organ donation system. The cardinal principles of altruism, autonomy, and public trust are important.
“… The past fifty years have brought a commendable significant increase in the number of lives saved through organ donation. However, the widening gap between the number of transplants performed and the number of people eligible for transplants is unacceptable. The UAGA provides a uniform and effective legal platform that preserves trust and is consistent with American values. Strong and committed leadership is needed to significantly reduce, if not eliminate, waiting lists for organs.”
The original UAGA represented a great achievement in American law, sweeping away the antiquated principles of the common law and the inadequate provisions of existing organ donor legislation, thus eliminating many of the impediments to the transplantation of vital organs. The original UAGA established the principle of consent and voluntary donation – it assumed that a donated organ was a “gift.” Fifty years later, UAGA remains an important act, and an achievement which the ULC should be justly proud.
The Sadler Brothers attended the 2018 Annual Meeting in Louisville and addressed the commissioners at the opening session. They ended their address by saying:
“The core principles of the UAGA are as valid today as they were in 1968. The Act has provided a sound and stable legal platform on which to base a transplant system. The number of transplants has steadily increased, to 38,000 – last year alone, an increase from 5,000 in 1995. Today, more than 141 million Americans are registered donors, which is over 55% of the eligible population. Unfortunately, the number of people waiting for transplants has grown even faster –117,000 last year, of whom 7000 died waiting for an organ.
“What are solutions? We must tackle head on – the runaway epidemic of obesity and diabetes which is creating an enormous need for more kidney transplants. In addition, some components of the current decentralized American system do not function optimally. More must be done to improve our system of organ procurement organizations, transplant centers, and donor registries.
“We thank Dean Stason and the members of his committee for their great work -- and for the opportunity to work closely with them. It was a life changing experience for us ---and we are honored to have been a part of it.
Congratulations to the Uniform Law Commission and your diligent work that has helped save the lives of thousands over the past 50 years!”