VCA Donation: legal framework and NEOB experience
Alexandra K. Glazier, JD MPH
VP & General CounselNew England Organ Bank
Legal framework: organ donation
Uniform Anatomical Gift Act (UAGA)
State law
For specific purposesTransplantation, research,
education
Based on gift law principles
Gift law as primary legal principle in UAGA
Gift law requires 3 elements:○ Intent○ Transfer○ Acceptance
A gift is a voluntary and legally binding uncompensated transfer
Legal Basis of Deceased Donation
UAGA is not based on informed consent principles
○ authorization○ legal permission
Informed consent is a legal principle that applies to healthcare treatment decisionsrisks and benefits to the patientdoctor patient fiduciary relationship
Legal Basis of Deceased Donation
State Law: UAGA Authorization based on
Donor’s decision (first person consent) ○Donor registries○Irrevocable gift upon death
Surrogate decision○In absence of first person consent
○Priority list (agent, next of kin)
UAGA and VCAs
Anatomical Gift broadly definedA donation of all or part of a
human body to take effect after death
VCAs fall under definition of “part”organ, eye or tissue
Donor Registries and VCAs
Donor Registries “any needed organ or tissue” specific donation
Experimental VCA protocols may be considered “research”Some donor registries include use
of the gift for research and some do not
Current NEOB Practice
Permission from Agent/Next of KinUnique privacy considerationsNewness of VCAsResearch context of VCA transplant
Approach families after organ donationPrioritize organ donationSelf-select families who are inclined to
donate
Current NEOB Practice
Specialized form
VCA form includes:Description of graft(s) to be donatedNeed for photos prior to recoveryAltered appearance of donor post-
recoveryMedia attention on recipient likelyDonor’s identity may be revealed
NEOB Experience
VCA donations coordinated:4 facial graft donations/ transplants2 sets of hand graft donations /
transplants
VCA consent rate:More than 50%
VCA post-donation donor family issues:None
NEOB Future Considerations
Multiple programs approved to perform VCA transplants
Regional allocation system being created
Matching criteria versus allocation priority
NEOB Future Considerations Matching Criteria
ABOHLAsizegender age rangeskin tone range
Allocation Priority0 antigen mismatchBilateral need for extremitiesWaiting time
NEOB Future Considerations
VCAs designated as “organs” RegulatoryAllocation
○ Sharing○ Priority
Authorization practices may change