The Uniform Anatomical Gift Act

Transplant surgery moved faster than the law. States began passing their own organ donation statutes in the 1960s, as transplantation became a real treatment, and each had different rules about rights over the bodies of the dead. In August 1967 the National Conference of Commissioners on Uniform State Laws drafted one model act for all of them. The commissioners adopted the Uniform Anatomical Gift Act in the summer of 1968, and the American Bar Association approved it. A. M. Sadler, B. L. Sadler and E. B. Stason made the case for it in JAMA that year as a model for reform.

Under the act any adult of sound mind could give all or part of the body, to take effect at death, in a document signed before two witnesses. If the person had neither agreed nor objected, the next of kin could give, in a ranked order that put a spouse ahead of adult children, parents and siblings. Hospitals, medical schools, universities and storage facilities could receive gifts for research and teaching, and named individuals could receive organs for transplantation. A physician had to declare the time of death. The act made the Uniform Donor Card a legal document of gift. It also listed stillborn infants and fetuses among possible decedents, which later drew it into disputes over fetal tissue research.

Adoption was quick. By 1971 every state and the District of Columbia had enacted the act, with few changes.

Two gaps showed with use. The act did not state in its text that a person's own decision to donate overrode the family's wishes; that appeared only in the commentary, which made it easier for procurement teams to give way to relatives who objected. It also said nothing about selling organs. The National Organ Transplant Act of 1984 banned the exchange of organs for valuable consideration, and the commissioners' 1987 revision adopted the ban. A 2006 revision widened the list of people who may consent for someone else and required people who refuse to donate to say so explicitly. By 2012, 45 states, the District of Columbia and the U.S. Virgin Islands had adopted the 2006 version.