How to register as an organ donor

Registering as an organ donor is the act of formally documenting one's decision to give organs, eyes, and tissue for transplantation after death. In the United States, registration constitutes "first-person authorization" (also called a "document of gift") under the Uniform Anatomical Gift Act (UAGA), and it is recognized as a legally binding expression of the individual's wishes. [1][2][3] A person can register through a state donor registry (most commonly when obtaining or renewing a driver's license or state ID), through the National Donate Life Registry, or through certain digital tools such as the iPhone Health app. [1][4]

Registration applies to donation after death (deceased donation). Becoming a living donation donor, for example, donating a kidney or a portion of a liver during one's lifetime, is arranged separately through a transplant center and is not handled through the deceased-donor registry. [1][5]

What registration means

When a person registers as a donor, the registration becomes a legal record of that person's decision to donate. [2][3] Under the 2006 revision of the UAGA, an adult who has documented consent to donate has made a gift that "is irrevocable and does not require the consent or concurrence of any person after the donor's death," and no other person can amend or revoke it. [3] This is referred to as first-person authorization. [2][3] One narrow exception in the model law is that if a registered donor who is a minor dies, a reasonably available parent may revoke or amend the gift. [3] For background on the statute itself, see Uniform Anatomical Gift Act (UAGA).

Registering does not create any obligation during a person's life, has no effect on medical care, and only takes effect after death has been declared and the person has been evaluated for medical suitability to donate. [6]

Ways to register in the United States

There are several ways to register, and a person may appear in more than one registry. [1][4]

• State driver-license or ID transactions. The most common way to register is through the state motor vehicle department when applying for or renewing a driver's license or identification card; many states then display a donor designation (such as a heart symbol) on the card. [1][7]
• Online state registries. Each U.S. state and the District of Columbia maintains its own donor registry, which can typically be joined online. The federal site organdonor.gov provides a state-by-state lookup that links to the correct registry. [1]
• The National Donate Life Registry. Donate Life America operates the National Donate Life Registry, accessible at registerme.org. Any adult age 18 or older can register there regardless of age or medical history, and the registration is described as a binding, legal document of gift. [4]
• Digital tools. Registration can also be completed through certain apps; for example, the iPhone Health app allows a user to sign up and transmits the registration to the national registry. [1][4]

At the time of a potential donation, donation professionals check both the relevant state registry and the National Donate Life Registry, and the most recent registration is honored as the legal document of gift. [4]

Who can register

Any adult age 18 or older can register to be an organ, eye, and tissue donor. [1][4] In many states, people younger than 18 may also sign up; however, because minors generally cannot enter a binding legal gift, a parent or guardian typically makes the final decision if a registered minor dies. [1][3]

There is no upper age limit for registration, and people with most medical conditions can still register. [4][6] Whether a registered person's organs or tissues can actually be used is determined at the time of death by the medical and donation teams based on a medical evaluation, not by the donor's age or self-assessed health. [4][6]

Choosing what to donate and telling family

Most states allow a registrant to specify which organs and tissues they are willing to donate, or to limit donation in other ways. [1] Donation organizations also encourage registrants to tell family members about the decision, so that relatives are not surprised and can help carry out the person's documented wishes. [1] Sharing the decision in advance is widely emphasized because, although registration is legally binding, family awareness reduces conflict and uncertainty at the time of donation. [1][3]

Updating or removing a registration

A person can change or withdraw a donor registration at any time. [1][8] Changes to a state registration are generally made through the same state online registry or motor vehicle department used to register, while changes to a National Donate Life Registry record are made through that registry's access portal. [1][8] Because both state and national registries are checked at the time of death, donation organizations advise updating or removing each registry in which a person is enrolled if they wish to change their decision. [4][8]

International approaches

The registration system described above reflects the United States' opt-in (first-person authorization) model, in which a person must affirmatively record a decision to donate. [1][3] Other countries use different legal models. Some use opt-in registries similar to the U.S. system, while others use opt-out or "deemed consent" systems, in which adults are presumed willing to donate unless they have registered an objection. [9] The existence of an opt-out law does not by itself determine a country's donation rate; comparative analyses indicate that organizational capacity in the health system is also a major factor. [9]

See also

• Organ donation
• What can be donated
• Living donation
• Deceased donation
• Uniform Anatomical Gift Act (UAGA)
• The transplant recipient journey

References

• Health Resources and Services Administration (HRSA) / OrganDonor.gov. "How To Sign Up." https://www.organdonor.gov/sign-up/how
• Gift of Life Michigan. "First-person authorization: What it is and how it works." https://giftoflifemichigan.org/blog/first-person-authorization-what-it-is-and-how-it-works
• Uniform Law Commission / Revised Uniform Anatomical Gift Act (2006), as summarized at Wikipedia, "Uniform Anatomical Gift Act." https://en.wikipedia.org/wiki/Uniform_Anatomical_Gift_Act
• Donate Life America. "National Donate Life Registry." https://donatelife.net/donation/donor-registries/national-donate-life-registry/
• OrganDonor.gov. "Living Organ Donation." https://www.organdonor.gov/learn/process/living-donation
• OrganDonor.gov. "Who Can Donate." https://www.organdonor.gov/learn/who-can-donate
• OrganDonor.gov. "Sign Up To Be An Organ Donor." https://www.organdonor.gov/sign-up
• Donate Life America. "Locate & Manage Your Donor Registration." https://donatelife.net/donation/donor-registries/removing-yourself-from-a-donor-registry/
• Rithalia A., et al. "A systematic review of presumed consent systems for deceased organ donation" / NCBI Bookshelf NBK56888. https://www.ncbi.nlm.nih.gov/books/NBK56888/