Brain Death Laws and Patterns of Consent to Remove Organs for Transplantation From Cadavers in the United States and 28 Other Countries

Patterns of practice were analyzed for the United States and 28 other countries with respect to consent to remove cadaveric organs for transplantation and the legal status of brain death as a basis for declaring death. The Uniform Anatomical Gift Act, adopted throughout the United States, allows either the donor or the family to give consent to remove cadaveric organs. In no state is consent presumed. The legal status of brain death as a basis for declaring death is established by statute in 25 states and by court decision in 7 more. Model brain death laws have been proposed recently by the American Medical Association and by the National Conference of Commissioners on Uniform State Laws. Both models are brief. They recognize the equivalence of brain death and death of a person without prescribing the medical criteria and tests used to establish the diagnosis of brain death. Seventeen of the 28 countries surveyed provide for donor cards similar to those used in the United States. In 15 countries consent to remove organs must be obtained from the donor or a family member. In thirteen, consent is presumed by law, but in 6 of the 13, the family is notified before proceeding with organ salvage. Brain death is recognized by statute or administrative law in 13 of 28 countries. In several of them, medical details and procedures for diagnosing brain death are incorporated into the laws and regulations. The number of cadaver organs salvaged fails to meet the needs of potential recipients in any of the countries. Possible modifications of attitudes, laws, and practice with respect to transplantation of cadaver organs are discussed.