Revised Uniform Anatomical Gift Act: Authorization, Registration, Revocation

The Revised Uniform Anatomical Gift Act is a model state law, adopted in 48 jurisdictions, that governs how a person donates organs, tissues, eyes, or an entire body after death. Its central rule is simple and powerful: once you register as a donor, your decision becomes legally irrevocable at death, and no family member or other third party can override it. The Act also spells out how to refuse donation, how to revoke a gift while you are alive, and who decides when someone dies without leaving any instructions at all.

What Counts as an Anatomical Gift

The Act applies to gifts of a whole body or specific parts for four purposes: transplantation, therapy, research, or education.¹ Covered parts include major organs such as hearts and lungs, along with tissues, skin, and eyes. Blood is not treated as “tissue” under the Act unless it is given for research or education.

Those four purposes are boundaries, not labels. A gift authorized only for transplantation cannot be redirected to medical education without separate authorization. Specifying one body part does not block a later gift of a different part by you or another authorized person, unless you expressly said otherwise.¹

A handful of states have not adopted the 2006 version, though each has its own anatomical gift statute.²

First-Person Authorization: Your Decision Controls

The Act’s most important provision is called first-person authorization. If you made an anatomical gift during your lifetime and did not revoke it before death, the law bars any other person from interfering with that gift.¹ The Act refers to this as the “preclusive effect.” Your registration locks everyone else out, including spouses, parents, and adult children. The only built-in exception involves unemancipated minors.

This rule was written to end a long-running problem: families overriding registered donors’ wishes at the moment of death because the earlier law was ambiguous about who had the final say. In practice, some organ procurement organizations still defer to objecting families, and the Act imposes no penalty when they do. Federal advisory committees have described this as an “unfounded fear of legal liability.”³ If you want your decision honored, telling your family in advance is still the best insurance.

How to Register as a Donor

The Act recognizes several ways to document your intent, and each carries the same legal weight:¹

Authorizing a donor symbol or statement on your driver’s license or state ID card.
Signing up through an online or state-operated donor registry.
Including donation instructions in your will. The gift takes effect at death whether or not the will goes through probate, and even if the will is later declared invalid for other reasons.
Signing a donor card or other written record.
During a terminal illness or injury, communicating your wish to at least two adults, one of whom is a disinterested witness.

If you cannot sign a written record yourself, another person can sign at your direction, but two adults must witness the signing and at least one must be disinterested.¹

One point that catches people off guard: canceling, suspending, or losing your driver’s license does not cancel a donation recorded on it. The gift survives independently of the license.¹

Recording a Refusal to Donate

The Act protects a “no” just as firmly as a “yes.” You can create a formal record of refusal using the same channels available for making a gift: a signed document, a statement in your will, or an oral communication during a terminal illness addressed to at least two adults with at least one disinterested witness.¹

An unrevoked refusal bars every other person from donating your body or any part of it after your death. You can amend or revoke that refusal using the same methods that created it.¹

Changing or Revoking a Gift While You Are Alive

If you registered as a donor and change your mind, the Act gives you several ways to pull the gift back:¹

Destroy the donor card or document that created the gift.
Update your status in the donor registry.
Create a new signed record that revokes the earlier gift.
During a terminal illness or injury, communicate the change to at least two adults, one of whom is a disinterested witness.

The revocation must happen before you die. Once death occurs, the gift is locked.

Revoking a gift is not the same as refusing donation. If you simply cancel a prior registration without filing a separate refusal, another authorized person such as a spouse or parent could still authorize a gift of your body or parts after death. To prevent that, create a record of refusal using one of the methods above.¹

Who Decides When There Are No Instructions

When someone dies without having registered and without a recorded refusal, the Act provides a priority list of people who can authorize donation. Medical teams must make a good-faith effort to reach the highest-ranking person who is “reasonably available,” meaning reachable without undue effort and willing and able to act within the narrow window organ preservation allows.

The order is:

A healthcare agent designated under a healthcare power of attorney.
Spouse or domestic partner.
Adult children.
Parents.
Adult siblings.
Adult grandchildren.
Grandparents.
The decedent’s guardian at the time of death.
A close personal friend or other person who showed special care for the decedent.

When a class has more than one member, any one of them can authorize the gift unless that person knows another member of the class objects. If there is a known objection, the gift can only proceed with majority agreement among the reasonably available members of that class.¹ Some state versions also allow a hospital administrator to authorize donation as a last-resort backstop when no family member is reasonably available and the decedent did not refuse.

Minors Are the One Exception

An emancipated minor can make a gift the same way an adult can. A non-emancipated minor who is old enough under state law to apply for a driver’s license can also register as a donor through the DMV.¹ For younger minors, a parent or guardian can authorize a gift on the child’s behalf.

Here is the one true exception to first-person authorization: when an unemancipated minor dies, a reasonably available parent can revoke or amend that minor’s gift after death. A parent can also revoke a minor’s recorded refusal after death, which can open the door to a family-authorized donation the minor had declined.¹

When Donation Meets an Advance Directive

Being registered as a donor and having an advance directive declining life-sustaining treatment can seem to collide. Organ donation sometimes requires short-term ventilator support or similar measures to keep organs transplant-viable, which can look like a contradiction of the patient’s end-of-life wishes.

The Act requires the attending physician and the prospective donor or the donor’s representative to confer and resolve the conflict. During that conversation, measures necessary to keep organs medically suitable may not be withheld, as long as continuing them is not medically harmful to the patient.¹

Donor registration does not give medical teams authority to change how someone dies. The decision to withdraw life-sustaining therapy is made independently of any donation discussion, and the physician who declares death cannot be part of the organ procurement or transplant team.

Coroner Cases, Immunity, and Cost

When a potential donor’s body falls under a coroner’s or medical examiner’s jurisdiction, such as in a homicide, accident, or unexplained death, the Act requires the examiner and the procurement organization to coordinate rather than giving either side absolute authority. If recovery would not interfere with the examination, the two sides must cooperate on timely removal. A coroner can ultimately deny recovery, but only if they reasonably believe the body part may be relevant to determining the cause or manner of death.¹

Anyone who acts in accordance with the Act in good faith, or makes a good-faith attempt to do so, is shielded from civil, criminal, and administrative liability. Neither the person who made the gift nor the donor’s estate is liable for any injury or damage resulting from the gift.¹ Medical teams may also rely on a family member’s stated relationship to the donor without demanding formal proof, unless they know the statement is false.

Donor families do not pay for organ recovery. Under federal regulations, hospitals bill organ procurement organizations for services provided to a deceased donor once care shifts from treating the patient to preserving organs. These “organ acquisition costs” are reimbursed through the transplant system, not charged to the donor’s estate.⁴ Funeral and burial expenses remain the family’s responsibility.

Buying or Selling Organs Is a Crime

Federal law makes it a crime to buy or sell human organs for transplantation when the transfer affects interstate commerce. Violators face a fine of up to $50,000, imprisonment for up to five years, or both.⁵ State versions of the Act reinforce this prohibition, and most classify the sale or purchase of body parts for transplantation or therapy as a felony. The Act’s framework assumes donation is a gift, not a transaction.

1
National Conference of Commissioners on Uniform State Laws. Revised Uniform Anatomical Gift Act (2006)
2
Uniform Law Commission. Spotlight ULC
3
Health Resources and Services Administration. Recommendations 19-28
4
eCFR. 42 CFR 413.418 – Amounts Billed to Organ Procurement Organizations for Hospital Services Provided to Deceased Donors
5
Office of the Law Revision Counsel. 42 USC 274e – Prohibition of Organ Purchases