1 the revised uniform anatomical gift law in michigan enhancing donor rights clarifying the donation...
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The Revised Uniform Anatomical Gift Law in
MichiganEnhancing Donor Rights
Clarifying the Donation Process
Amy Olszewski, MPA
Government Liaison, Gift of Life Michigan
April 16, 2008
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Revised Uniform Anatomical Gift Law (UAGL)
The Revised UAGL is designed to:• Make laws consistent among states and
with national regulations.• Reinforce a person’s right to make a
decision about what will happen to his or her body and/or body parts after death.
• Address and eliminate some of the legal conflicts or “gray areas” faced in everyday practice.
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Revised Uniform Anatomical Gift Law (UAGL)
• Michigan’s law was signed on March 13, 2008, and takes effect May 1.
• Michigan is the 22nd state to adopt the uniform law.
• The Association of Organ Procurement Organizations (AOPO) and the Uniform Law Commissioners want every state to have the new law by mid-2009.
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The Revised UAGA Nationally
As of April 11, 2008, 25 states have enacted the UAGA and Georgia and Alaska’s expected approval is imminent.
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What Gift of Life does…
…is firmly based in law and regulations.The Revised UAGL:• Protects the donor• Protects the procurement organization• Protects medical personnel and the hospital• Protects the transplant center and recipient
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How does the UAGL…
• Reinforce everyday practice?
• Increase collaboration between the hospital and organ procurement organization?
• Help enforce patient rights?
• Help resolve potential conflicts?
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• Hospitals answer to federal regulations through the National Organ Transplant Act and Centers for Medicare and Medicaid Services (CMS) regulations.
• Also, there are accreditation requirements through The Joint Commission (formerly known as JCAHO) and the American Osteopathic Association.
• Recognizing this, the UAGL eliminates Michigan’s requirement for hospitals to keep or maintain Organ Donation Log Sheets, also called Routine Notification logs.
Current Practices
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What are the requirements regarding the hospital/OPO relationship?
Section 333.10115 Each hospital in this state shall enter
into agreements or affiliations with procurement organization for coordination of procurement and use of anatomical gifts.
Current Practices
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Among others, the revised UAGL retains the following provisions of anatomical donation:
1) The donor or the person giving consent for donation may direct their anatomical gift to a certain individual on the waiting list (“directed donation”).
2) The physician who works to save the donor’s life cannot participate in the recovery of organs or tissues.
3) The UAGL provides “good faith” protection for medical personnel, the hospital and the organ procurement organization. This is expanded to include protection if consent is obtained from a person misrepresenting their relationship to the donor.
Current Practices
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Increased Collaboration
Opportunity: More Medically Suitable Referrals
Under the revised UAGL, medical suitability must be maintained prior to and while Gift of Life seeks consent.
This will give every donor a chance to have their wishes honored. Every family will also have the opportunity to make a decision to donate.
Action: How can your facility support the right of every patient and their family to be given the opportunity to donate?
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Increased Collaboration
Required Search for Document of Gift
The UAGL now has a provision that the hospital, as soon as is practical after necessary medical intervention, searches for any document regarding donation on all patients at or near death.
Opportunity: Fulfill every person’s wish regarding donation
Action: How can this be most effectively conveyed to hospital staff?
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Enforcing Patient Rights
First person consent is reasserted in the UAGL.
A person’s wish to donate, indicated through a document found by Gift of Life, the hospital or any other person, is nonrevocable after death.
Only a parent can revoke the decision of a minor, unemancipated child. Otherwise, the gift cannot be changed or denied by any other person.
This is not new. It is, however, more clearly stated in the revised UAGL.
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Enforcing Patient Rights
New concept: Refusal
A refusal is usually a written statement, signed by the patient. It could say, “I do not wish to be a donor.”
It can only be given by the patient verbally if they are unable to sign a document or if they are injured or terminally ill. If the patient does state a verbal refusal, it must be written down and signed by two witnesses, one of whom is disinterested.
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Enforcing Patient Rights
The refusal must be presented to the hospital and faxed to Gift of Life Michigan.
In the presence of a refusal, medical suitability cannot be assessed and the organ procurement organization cannot approach for consent.
• Opportunity: Fulfill every person’s wish regarding donation
• Action: How can your facility ensure that a patient’s wish is known regarding donation?
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Resolve Potential Conflicts
The revised UAGL recognizes that it is possible to have conflicting documents.
- a patient has a signed document of gift (donor registration)
- a patient has a written advance directive that states they do not want to be maintained on artificial life support
How does the UAGL advise us to proceed?
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Resolve Potential Conflicts
The law specifically addresses this situation.
The physician, the patient or their representative, and the hospice medical director, if applicable, are to huddle to talk about the patient’s conflicting wishes.
The organ procurement organization is to participate in the huddle by providing guidance about the donation process.
The decision reached by the patient or their representative will be honored.
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Resolve Potential Conflicts
If the patient has a written advanced directive and no document of gift, medical suitability must be maintained so the family can be approached for consent.
• Opportunity: Provide the patient or the patient’s representative the chance to make a decision regarding donation – perhaps a decision they never considered.
• Action: How can your facility ensure that Gift of Life Michigan is contacted in a timely manner on every patient at or near death so medical suitability can be assessed?
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UAGL in Everyday Practice
The revised UAGL is a straight-forward measure that brings the organ, tissue, and eye donation process into line with federal requirements.
More concepts are included in the UAGL that affect Gift of Life’s everyday practice.
All designated requestors will need to be retrained in this complex, new law.
Gift of Life Michigan is your source for addressing issues quickly and accurately.
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UAGL in Everyday Practice
Introductory letters were sent the week of April 7, 2008 to all hospital CEOs.
- The Executive Summary
- The UAGL (Public Act 39 of 2008)
Your Gift of Life hospital representative can assist you in implementing this law and integrating the UAGL seamlessly into your everyday practice.
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Send questions or concerns to:
Your Gift of Life Hospital Representative
Richard Pietroski, Executive DirectorGift of Life [email protected]
Amy Olszewski, Government [email protected]