The Effect of Uniform Anatomical Gift Act of 2006 on Organ Donations and Transplants

Organ transplants are among the most remarkable innovations produced by modern medicine. Improvements over the past 20 years in organ preservation, surgical techniques, and post-operative care have increased both survival rates and quality of life for recipients. These improvements have also increased the pool of individuals for whom a transplant is a viable option.

But this increase in demand for organs has not been matched by a similar increase in supply. Laws in most countries prohibit market transactions in organs and so the vast majority of transplanted organs come from donations, either from live donors or cadavers. In the US, median waiting times for a donor organ vary from several months (e.g., heart, lungs) to several years (kidneys).

In an effort to address the shortage of organs, the National Conference of Commissioners on Uniform State Laws (ULC) proposed the Uniform Anatomical Gift Act of 2006 (UAGA 2006). The ULC promotes the passage of uniform laws across states to provide clarity and stability across state boundaries in a variety of legal areas. The intent in creating the UAGA 2006 was to provide a uniform system across states in the identification and processing of donated organs from deceased donors, and in the maintenance and access of organ donor registries. The goal was to streamline the process of identifying potential organ donors, overcome legal barriers to obtaining or verifying consent to use organs from a decedent, and increase efficiency in the processing of usable organs.

The ULC drafted the statute in 2006 and presented it for adoption by state legislatures. Arkansas was the first state to enact the new law in March of 2007. Since that time, all but three states have enacted the law.

We evaluate the effectiveness of the 2006 UAGA in increasing the number of transplants from deceased donors and in improving the functioning of other elements of the donation, recovery and transplantation process. We use data from the Organ Procurement and Transplantation Network (OPTN) and Scientific Registry of Transplant Recipients (SRTR) which have collected information on all organ donors and all organ recipients of solid organs (kidney, pancreas, heart, lung, liver, intestine) in the U.S. since 1988.

The primary outcome of interest is the number of transplanted organs from deceased donors in a given state and year. We also examine the efficiency of the system in processing donated organs measured as the number of organs donated per deceased donor.  We use a difference-in-difference strategy that exploits the variation in state adoption date and accounts for state and year fixed effects. Our initial results suggest the reforms have had little effect on donations and transplants, although those results are subject to change. In particular, we are evaluating what appears to be a downward trend in the number of available deceased organs donors during that time that is apparently independent of the law changes.