Authorization

First-person authorization for donation (authorization by the donor himself or herself) proclaims an individual's desire to make the anatomical gift and requires no further authorization from the next-of-kin. The Uniform Anatomical Gift Act protects the right of individuals to donate their organs and tissues, and requires that OPOs and hospitals honor the donor's wishes. An individual can authorize organ donation either through filling out a donor card, registering online, making a designation on their driver's license or state ID, or by executing a living will. The most common method is to join a state donor registry when renewing a driver's license or state ID. While the driver's license/state ID may display an individual's designation status, the actual registration is in a state-operated secure database. When a patient at imminent risk of death is referred to the OPO, the donor referral coordinator queries the state donor registry to determine the patient's donor designation status. If the patient is a designated donor and medically suitable for donation, the hospital and OPO are legally obligated to honor the donor's wish.

Next-of-kin authorization is only considered if the potential donor is medically suitable to donate and if there is no evidence of first-person authorization. When requesting authorization, the procurement coordinator provides all possible donation options, discusses the impact of donation on funeral arrangements, gives a general description of the recovery process, and explains that the family will not incur any cost for donation. Institutional support personnel including social workers, chaplains, and nursing staff are involved when appropriate, but only the OPO staff should approach the family with the request for donation. Two important considerations for this type of authorization are: 1) the individual to be approached for authorization, and 2) the timing of the request for donation.

The Uniform Anatomical Gift Act (UAGA) establishes the order of priority in which the next-of-kin are approached for organ donation conversation. The UAGA requires OPOs to make reasonable efforts to approach the next-of-kin with highest priority, and, if not available, proceed down the order to the next available person. The law states that "A person may not make an anatomical gift if, at the time of the decedent's death, a person in a prior class under subsection (a) is reasonably available to make or to object to the making of an anatomical gift." If two or more individuals are in the same class, consensus of the absolute majority is required for authorization.

The timing of the donation request is crucial and the request for authorization should be "decoupled" from the news that the family's loved one has died. Decoupling refers to the temporal separation of pronouncement of death from the request for donation. Bartucci and Bishop recommend that request for organ donation to be made only after the family has had sufficient time to accept the death of their loved one. ³⁸ Rudy et al. also suggest a similar disconnect in the pronouncement of death and the request for donation.