Free Organ Donation Form

"Brain Dead" Donors
The organ donations that are made in the organ donation document take effect on death. Organs such as the heart, lungs, and pancreas are only useable for transplantation if they are removed from a person whose body is maintained on life support systems after they are declared "brain dead." The circulatory and respiratory functions of a person who is brain dead can be temporarily and artificially maintained until the person's organs can be removed. The artificial life support is necessary to maintain an adequate blood supply to the organs so they are suitable for transplantation. Nearly all states legally define death as either the irreversible cessation of all functions of the entire brain (brain death) or the irreversible cessation of circulatory and respiratory functions. Trauma to the head, bleeding into the brain, and lack of oxygen to the brain are some of the causes of brain death.

Non-"Brain Dead" Donors
Most people do not die under circumstances where organs such as the heart and liver can be transplanted into another person; in other words, they do not suffer brain death. However, even if a person is not brain dead, some of their organs, tissues, or parts may still be useful. Such issues as the cornea, bone, and skin do not need to come from a brain dead person whose body is artificially maintained on life support. However, all organs or tissues must be removed within a relatively short time after death.

After Removal
Organs are removed after death in such a way as to minimize visible signs of the removal. Unless other arrangements have been made, the body of a donor is typically available for funeral and burial arrangements after organs and tissues are removed.

The Uniform Anatomical Gift Acts allow a donor to designate a "donee", the individual or institution who is to receive the donated organs and tissues. HOWEVER, since not all donees can use a donation for any purpose, care must be taken to avoid inadvertently restricting or essentially revoking a donation. For example, a medical or dental school, college, or university is generally not authorized to use organs or tissues for transplantation or, in some states, for therapy. Individuals, except for physicians and surgeons, can only use organs or tissues for transplantation or therapy needed by that individual. Some states prohibit designating a donee on the basis of race, age, religion, color, national origin, ancestry, gender, sexual orientation, or physical or mental handicaps. Several states indicate a "preference" so that residents of the state where the organ was donated receive the organ if possible.

If No Donee Is Designated
If there is no designated donee or the designated donee is not available or rejects the donation, depending on the specific state law either the attending physician or any hospital can generally accept the donation. Once a donee accepts organs and tissues, that donee can then transfer the organ and tissues so that the tissues are ultimately received by a party who will use them. There is a national system to allocate organs to individuals who need them for transplantation. Factors such as the urgency of the prospective recipient's need for the organ, the closeness of the biological match between the donor and prospective recipient, and geographic proximity help determine who receives donated organs.

Acceptable Donees
In general, the following are acceptable donees: hospitals; surgeons; physicians; accredited medical or dental schools, colleges, or universities; organ/tissue banks or storage facilities; organ procurement organizations; or a specified individual who needs an organ or tissues for therapy or transplantation. Some states have additional permissible donees, such as schools of veterinary medicine, nursing schools, or health departments. Mississippi actually incorporates acceptable donees and the purposes for which a donation can be used into the donor form.

In general, state laws provide which family members or other individuals are authorized to make organ donation decisions concerning a deceased individual's body. Family members may be involved even if a deceased individual had completed a donor form during life. For example if the form is invalid for any reason or is not located when an individual dies, the family may be asked to make a donation decision. Additionally, it is common practice for health care providers to ask family members for consent before removing organs and tissues after an individual's death EVEN IF that individual had completed a valid donor form and the form is located. It is recommended that you discuss your wishes with your family and that you carry any organ donation form that you have completed in your wallet or purse.

Who Donates
In many states, individuals are asked to make organ donation decisions concerning deceased individuals in the following order: spouse, adult children, parents, adult siblings, and guardian. Some states give an agent under a health care power of attorney document the authority to make organ donation decisions. States differ on whether the agent has priority over family members in decision making and whether the power of attorney instrument must specifically give the agent power to make organ donation decisions. It is recommended that if you desire that an agent have the power to make organ donation decisions, this should be specifically stated in the power of attorney document. Whether the agent will be able to make donation decisions will likely depend on the state law that applies.

Medical Examiners and Coroners
Many states also provide that the organs and tissues of a body in the custody of a medical examiner or coroner may be removed under certain circumstances. Generally, removal is not allowed if there is an objection by the deceased individual's next-of-kin or if it is known that the deceased individual did not want to be an organ donor.

Many states provide that donor information can be or will be incorporated into drivers licenses and identification cards. States use the following methods for this purpose:

• imprinting or attaching a symbol to a license or card that indicates an individual is a donor or is willing to be a donor;
  
• imprinting an actual donor form on the reverse side of a license or card to be completed when the license or card is issued; and
  
• providing the opportunity for donor form completion at the time of license or card application with a possible indication on the license of an individual's donor status or even filing of donor forms with a state office.

Revoking License Donations
State laws vary on whether the revocation, suspension, or expiration of a license that contains a donation effectively revokes a donation. Additionally, states have various methods to revoke such donations, such as crossing through the form on the license, signing a revocation on the back of a license, destroying the card that accompanies a license, or sending written notice to the motor vehicle office.

If you desire to revoke or amend a donation made or reflected on a drivers license, you should follow any instructions provided at the time of the donation. If there are any doubts about the status of a drivers license donation, it is recommended that the state officials responsible for the administration of the drivers licenses or donor forms be contacted concerning the revocation of a donation. At a minimum, it is recommended that you carry any new organ donation forms or revocation documents with the license or identification card so that the revocation or new form will likely be discovered.

It is important that a revocation of a donor form be communicated to anyone who had previously received a copy of the now-revoked form. It is recommended that the following actions be considered in addition to indicating a revocation in this program's form:

• If you have a copy of the now-revoked donor form, it is recommended that it be destroyed.
  
• If you had previously sent copies of the now-revoked donor form to other parties, such as a designated donee, it is strongly recommended that a copy of the revocation and any new forms also be sent to those parties.
  
• It is recommended that you communicate any revocations of prior donations and your current wishes concerning organ donation to your family. Family members are often involved in organ donation decisions so it is important that they are aware of the existence of completed donor forms or revocations and your wishes.

Designated Individuals to Perform Procedures
You may indicate a physician or other trained person to carry out the procedure in the "Limitations or Special Wishes" section of the form. However, not all physicians or surgeons would be qualified or willing to carry out the necessary procedures to remove organs and tissues for donation. Additionally, the laws of some states do not allow an attending physician or physicians designated as donees to perform retrieval procedures. If there is no individual designated on a donor form to perform the procedures or if that individual is unavailable, appropriate individuals will be authorized to carry out the procedures.

Appropriate Individuals
State laws vary on what individuals are allowed to remove organs and tissues. Generally, physicians, surgeons, specially trained technicians or procurement specialists, and individuals specially trained in eye removal, may remove organs and tissues.

If you desire to narrowly limit a donation to a specified donee, you are encouraged to contact the donee (such as a medical school or hospital) or an organ procurement organization in your state to assure the necessary steps are taken and the form is completed correctly to accomplish your specific goal.

State Limitations
Several states additionally limit who can accept donations. Ohio, Vermont, and Utah limit donees to:

• hospitals, surgeons, physicians, or recovery agencies (able to receive gifts for any purpose authorized by law) or
  
• medical or dental schools, colleges, or universities (able to receive gifts for education, research, or the advancement of medical or dental science).

In general, the laws of all states provide that an individual may make an organ donation by completing a document. Generally the document may be a card carried with the individual, an imprint on or attachment to a drivers license, or any other document. Organ donations may also be valid if contained in a will. The use of a will as the only method to donate organs is not recommended because such instructions might not be made known in time to allow organs or tissues to be donated.

Ohio and Mississippi require that an organ donation document substantially conform to the form provided in Ohio and Mississippi state law. This program provides the Ohio and Mississippi forms substantially as those forms appear in state law. This program provides Ohio and Mississippi donors the opportunity to supplement the standard forms with optional sections and provides donors with optional language to complete the states' forms.

If you have specific questions about your state's requirements, it is recommended that you contact a lawyer. You can also contact a local hospital, an organ procurement organization, or another health care agency for more information about organ donation in your particular state.

You are encouraged to read the topic, Donations by Others, for information on the important role that family members play in the organ donation process.

The medical screening associated with the donation of organs and tissues will most likely include testing for infectious diseases such as Hepatitis and the Human Immunodeficiency Virus (HIV), the virus that causes Acquired Immune Deficiency Syndrome (AIDS). Such testing can generally be done without any additional consent from you or your family. It is possible that your family could be informed if the result of an HIV test was positive.

HIV Positive Donors
It is a crime in some states for an individual to attempt to donate organs or tissues if they know they are HIV positive and know that the HIV virus may be transmitted by a donation. If an HIV positive individual desires to donate his or her organs or tissues for purposes such as research and education, this program's form should not be used. Instead, specific arrangements should be made for such a donation with a medical research or educational facility.

The Uniform Anatomical Gift Act and the majority of states provide that an individual 18 years of age or older can execute an organ donation document. Nebraska requires an individual to be 19 years of age. Maine and New Mexico, and Louisiana under certain circumstances, allow an individual 16 years of age or older to execute a donor document.

States Allowing Minors to Donate
Some states allow a minor to make a donation, including: California, Delaware, Indiana, Iowa, Kansas, Maryland, Minnesota, Ohio, Pennsylvania, Virginia, Wyoming, Nevada, South Dakota, Texas, and Washington. This program provides for the signature of a minor's parent or guardian as generally required by the states allowing a minor to complete an organ donor form. Although several states allow a minor 16 years old or older to execute a document, it is recommended that parental or guardian consent be obtained for minors in all states to increase the likelihood that their donations would be honored in any state.

States That Are Silent
Even in states where state law does not provide that minors can donate organs and tissues, minors are encouraged to complete an organ donation form if they have an opinion about the donation of their organs. A completed form indicates the wishes of a minor and may assist a parent or legal guardian in making a donation decision at a later time.

Parents Preferred
Some states prefer that parental consent be obtained even if a guardian has been appointed for a minor. Delaware specifically requires parental consent unless a parent is no longer living or no longer has contractual capacity. This program's form provides for both parents' signatures although this is not required by any state. If both parents are available and willing to consent to the donation, both signatures on the form may facilitate the actual donation process at a later time.

State Specifics
There are several state-specific rules concerning donations by minors. South Dakota and Iowa only allow a minor 14 years old or older to execute a document with the consent of a parent or guardian. However, even minors under the age of 14 are encouraged to complete a donor form to indicate their wishes. Delaware exempts married minors from the requirement of parental or guardian consent. Ohio, Wyoming, and Nevada (for a minor 12 or older) require that one of two witnesses be a parent or guardian. For Nevada minors under the age of 12, a parent or guardian must sign on behalf of the minor with two additional witnesses and the actual donor need not sign. Indiana, Kansas, and Maryland allow minors to donate when they obtain a drivers license. Texas and Washington require parental consent for a form to be valid if the minor actually dies before the age of 18.

Organ donations are often referred to as "anatomical gifts". All fifty states have passed some version of the Uniform Anatomical Gift Act, generally providing that you may make a gift of your organs and tissues during your lifetime with the gift to take effect on your death. Additionally, family members may generally donate your organs and tissues after your death if there is no indication you were opposed to such a donation. It is therefore important for you to document your wishes concerning organ donation.

Options
Consistent with the latest version of the Uniform Anatomical Gift Act, this program provides you the opportunity to:

• make a donation of organs and tissues to take effect on death,

• amend or revoke a prior organ donation, or

• document the refusal to make an organ donation.

The Organ Donation Form only deals with the donation of organs after death. Donations of organs or tissues before death, such as donating blood, bone marrow, or one kidney, is a completely different process. Because the donor is alive for such a donation, consent would generally be obtained at that time.

There could be circumstances where a person is alive but unable to give consent to an organ donation. For example, if a person suffers an injury or disease that results in a comatose state, that person would be unable to communicate and give consent to an organ donation. If a family member of that person could benefit from a bone marrow or kidney transplant it might be difficult to obtain permission for the comatose person's organ to be transplanted into the needy family member even though it is medically feasible to do so. Courts have dealt with this issue in the context of mentally incompetent individuals with family members who need organ transplants. It may be helpful to document beliefs on this topic or designate another individual to make such decisions in the event an individual is unable to do so in the future. Documents such as a health care power of attorney or advance health care directives could be helpful for this purpose.

Unless you specifically desire to exclude certain organs, tissues, or parts from donation, it is recommended that you simply indicate that "any needed organs, tissues, or parts" are donated. Checking the "any needed" option provides flexibility to allow the greatest possible use of your organs, tissues, and parts after death.

Body Donations

Some organ donation forms allow you to make an anatomical gift of the entire body. However, the donation of one's entire body often requires specific arrangements with the designated recipient of the body, such as a medical school. Consistent with the most recent Uniform Anatomical Gift Act, this program's document is not designed for donation of an entire body. You should contact a medical school if you desire to make such a donation.

You are encouraged to read the topic, Brain Death and Organ Donation Procedures, for more information on the circumstances under which some organs can be used for transplantation.

If you are amending or revoking a previous document, you may need to take extra steps to assure that a new organ donation form is honored at your death. For example, if an original donor form was delivered to a hospital or physician, they should be notified if it is revoked.

It is generally recommended that the individuals who witness the Donor's signature not have a special interest in the donation of the Donor's organs or tissues. For example, a designated donee should not witness the Donor's signature.

Some individuals and organizations advocate innovative approaches to increase the supply of organs available for transplantation. "Presumed Consent" is a system where it is presumed that all individuals would consent to the donation of their organs. Individuals must specifically state a desire not to be an organ donor to avoid having their organs, tissues, or parts removed at their death. Some European countries have this system and similar legislation has been introduced (but not passed) in the United States.

Legislation has been introduced in several states that would allow convicted criminals who are sentenced to death to choose a method of execution that would permit the donation of his or her organs for transplantation.

The latest version of the Uniform Anatomical Gift Act provides that you can document a refusal to donate organs. Even states that do not expressly address "refusal to donate" documents provide that your wishes NOT to be an organ donor are to be honored at your death.

If you do not want to be an organ donor for any reason, it is recommended that you document your refusal to donate regardless of whether your state specifically provides for such a document. A documented refusal may assist others in making a donation decision that is consistent with your wishes. If you have specific questions about refusing to be an organ donor it is recommended that you contact a lawyer.

The help topic, Donations by Others contains information on the important role that family members play in the organ donation process.

There has been substantial activity aimed at increasing the availability of organs for transplant purposes because organ demand far exceeds supply. Many states require that hospitals ask patients if they have completed a donor form or if they would like to do so when they are admitted to a hospital. Hospitals may also request copies of organ donation forms for your medical record. Additionally, federal law requires most hospitals to identify potential organ donors and inform their families about the possibility of organ donation near or at the time of death.

Revocation
To avoid any confusion that may arise if more than one donor form is located after your death, it is advisable to revoke old donor forms when a new donation form is completed. If you have previously completed a donor form and now wish to make changes, it may be easiest to simply revoke the old form and complete a new form. Caution: If a previous donation form was delivered to a specified donee, many states require that a copy of the revocation or communication of the revocation also be sent to that donee.

Amendment
If, however, there is something specific on an old donor form that you do not wish to revoke, a new form could be designated as amending the previous form. For example, you may have signed specific forms for the donation of just eyes or kidneys. Those forms may be silent about other organs and tissues and you may wish to add the donation of other organs. Depending on the circumstances, it may be preferable to leave a specific donation in effect and to establish a new form as an amendment. It is recommended that new donor forms that "amend" previous forms be consistent with previous forms if possible. For example, if you previously completed a form donating only your eyes, it is recommended that you also donate your eyes on the new donor form (unless you have changed your mind on eye donation).

If you are revoking or amending a previous form, you should read the topic, Extra Steps at Revocation.

The severability provision provides some protection against the possibility that an entire organ donation form might be declared invalid simply because a state law does not permit a specific provision that was included in the form. For example, it is possible that an unusual request under the "Limitations or Special Wishes" section would not be enforceable. If that occurred, the inclusion of the severability provision would decrease the possibility that the unusual provision would cause the entire organ donation form to be invalid.

All states require that you sign the document making an organ donation. (State laws generally provide that another person may sign on your behalf if you are physically unable to sign.) Generally, you must be competent to execute a valid document. Generally, "competency" is the mental ability to understand the general effect of a transaction or document. Every adult is presumed to be competent. You should consult a lawyer if there are questions about competency.

Incompetency
If you have a court-appointed guardian or conservator, or have been determined incompetent, you or your guardian should consult a lawyer to obtain advice about completing a donor form. A document completed and signed by an individual who was not competent may not be valid. If a donor form is invalid, the would-be donor's family or guardian would likely be asked to make any organ donation decisions.

1. All of the signature blanks on the organ donation form should be completed. Depending on the donor's selections, the form should be signed by the donor, the donor's representative, or the donor's parents or guardians. The donor should indicate the date the form is signed. The donor should carefully review the form to assure all required signatures are obtained.

2. Witnesses should be present when the form is signed and should then sign where indicated on the form.

3. The donor should tell family members or close friends about the form and the donor's wishes concerning organ donation.

4. The donor may give a copy of the form to any donee designated on the form to receive the donor's organs and tissues at the donor's death. A copy may also be given to any other individual or institution willing to keep a copy of the form such as a family physician or local hospital.

5. If this form is later revoked or amended, the donor should communicate that revocation or amendment to whoever has received a copy of this form. The donor should then carry the revocation and any new form in a wallet or purse.

The Uniform Anatomical Gift Acts provide that organs, tissues, or parts may generally be used for transplantation, therapy, research, and medical education. However, it is not always possible for organs and tissues to be used for all purposes. Some organs or tissues may not be used if it would interfere with an autopsy or another investigation. Additionally, if you suffer from a particular disease or die under certain circumstances, your organs and tissues may not be suitable for transplantation. Certain medical tests will be completed to assure that organs and tissues are acceptable for transplantation or therapy. Organs and tissues not useful for transplantation or therapy may be useful for research or education.

You are encouraged to read the topic, Medical Screening, for important information about testing for the HIV virus.

Some states do not require that an organ donation form be witnessed at all, only signed by the donor. The majority of states, however, still require two witnesses for a valid execution of a donor form. It is recommended that two witnesses sign this program's Organ Donation Form so that it is more likely to be honored in all states.

For the most part, states do not restrict who can witness an organ donation form. Generally, witnesses should be adults, mentally competent, and present when you sign the form. It is recommended that witnesses not have a special interest in the donation of the organs such as being designated as a recipient of an organ.