Chapter 476

2007 -- S 729 SUBSTITUTE A AS AMENDED

Enacted 07/06/07

 

A N  A C T

RELATING TO HEALTH AND SAFETY -- UNIFORM ANATOMICAL GIFT ACT

          

     Introduced By: Senators Miller, Algiere, Connors, Perry, and C Levesque

     Date Introduced: February 15, 2007

    

It is enacted by the General Assembly as follows:

 

     SECTION 1. Chapter 23-18.6 of the General Laws entitled "Uniform Anatomical Gift

Act" is hereby repealed in its entirety.

 

     CHAPTER 23-18.6

Uniform Anatomical Gift Act

 

     23-18.6-1. Definitions. -- As used in this chapter:

      (1) "Anatomical gift" means a donation of all or part of a human body to take effect upon

or after death.

      (2) "Decedent" means a deceased individual and includes a stillborn infant or fetus.

      (3) "Document of gift" means a card, a statement or symbol attached to or imprinted on a

motor vehicle operator's or chauffeur's license, inclusion in the Rhode Island Donor Registry, a

will, or other writing used to make an anatomical gift.

      (4) "Donor" means an individual who makes an anatomical gift of all or part of the

individual's body.

      (5) "Enucleator" means an individual who is licensed or certified by the state board of

medical examiners and/or department of health and/or federally designated eye procurement

organization to remove or process eyes or parts of eyes.

      (6) "Hospital" means a facility licensed, accredited, or approved as a hospital under the

law of any state or a facility operated as a hospital by the United States government, a state, or a

subdivision of a state.

      (7) "Part" means an organ, tissue, eye, bone, artery, blood, fluid, or other portion of a

human body.

      (8) "Person" means an individual, corporation, business trust, estate, trust, partnership,

joint venture, association, government, governmental subdivision or agency, or any other legal or

commercial entity.

      (9) "Physician" or "surgeon" means an individual licensed or otherwise authorized to

practice medicine and surgery or osteopathy and surgery under the laws of any state.

      (10) "Procurement organization" means federally designated eye or organ procurement

organization accredited, and/or approved under the laws of any state for procurement,

distribution, or storage of human bodies or parts.

      (11) "State" means a state, territory, or possession of the United States, the District of

Columbia, or the Commonwealth of Puerto Rico.

      (12) "Technician" means an individual who is licensed or certified by the State Board of

Medical Examiners and/or department of health and/or federally designated eye procurement

organization to remove or process eyes or parts of eyes.

 

     23-18.6-2. Making, amending, revoking, and refusing to make anatomical gifts by

individual. -- (a) An individual who is at least (18) years of age may:

      (1) Make an anatomical gift for any of the purposes stated in section 23-18.6-6(a);

      (2) Limit an anatomical gift to one or more of those purposes; or

      (3) Refuse to make an anatomical gift.

      (b) An anatomical gift may be made only by a document of gift signed by the donor or

by indicating consent to donate under chapters 10 and 10.1 of title 31. If the donor cannot sign,

the document of gift must be signed by another individual, the next of kin, or designee and by two

(2) witnesses, all of whom have signed at the direction and in the presence of the donor and of

each other, and state that it has been so signed.

      (c) If a document of gift is attached to or imprinted on a donor's motor vehicle operator's

or chauffeur's license, revocation, suspension, expiration, or cancellation of the license does not

invalidate the anatomical gift.

      (d) A document of gift may designate a particular physician or surgeon in cases of living

relation donation and transplantation to carry out the appropriate procedures. In the absence of a

designation or if the designee is not available, the donee or other person authorized to accept the

anatomical gift may employ or authorize any physician, surgeon, technician, or enucleator to

carry out the appropriate procedures.

      (e) An anatomical gift by will takes effect upon death of the testator, whether or not the

will is probated. If, after death, the will is declared invalid for testamentary purposes, the validity

of the anatomical fight is unaffected.

      (f) A donor may amend or revoke an anatomical gift, not made by will, only by:

      (1) A signed statement;

      (2) An oral statement made in the presence of two (2) individuals;

      (3) Any form of communication during a terminal illness or injury addressed to a

physician or surgeon; or

      (4) The delivery of a signed statement to a specified donee to whom a document of gift

had been delivered.

      (g) The donor of an anatomical gift made by will may amend or revoke the gift in the

manner provided for amendment or revocation of will, or as provided in subsection (f).

      (h) An anatomical gift that is not revoked by the donor before death is irrevocable and

does not require the consent or concurrence of any person after the donor's death, except in cases

where the deceased is under the age of eighteen (18). In cases where the deceased is under the age

of eighteen (18), an anatomical gift shall be made as set forth in section 23-18.6-3.

      (i) An individual may refuse to make an anatomical gift of the individual's body or party

part by: (1) a writing signed in the same manner as a document of gift; (2) a statement attached to

a donor's motor vehicle operator's or chauffeur's license; or (3) any other writing used to identify

the individual as refusing to make an anatomical gift. During a terminal illness or injury, the

refusal may be an oral statement or other form of communication.

      (j) In the absence of contrary indications by the donor, an anatomical gift of a part is

neither a refusal to give other parts nor a limitation on an anatomical gift under section 23-18.6-3

or on a removal or release of other parts under section 23-18.6-4.

      (k) In the absence of contrary indications by the donor, a revocation or amendment of an

anatomical gift is not a refusal to make another anatomical gift. If the donor intends a revocation

to be a refusal to make an anatomical gift, the donor shall make the refusal pursuant to subsection

(i).

 

     23-18.6-3. Making, revoking, and objecting to anatomical gifts by persons other

than the donor. -- (a) Any member of the following classes of persons, in the order of priority

listed, may make an anatomical gift of all or a part of the decedent's body for an authorized

purpose, unless the decedent, at the time of death, has made an unrevoked refusal to make that

anatomical gift:

      (1) The spouse of the decedent;

      (2) An adult son or daughter of the decedent;

      (3) Either parent of the decedent;

      (4) An adult brother or sister of the decedent;

      (5) A grandparent of the decedent; and

      (6) A guardian of the person of the decedent at the time of death.

      (b) An anatomical gift may not be made by a person listed in subsection (a) if:

      (1) A person in a prior class is available at the time of death to make an anatomical gift;

      (2) (i) The person proposing to make an anatomical gift knows of a written refusal or

written contrary indications by the decedent, provided that the decedent has signed a document of

gift; or

      (ii) If the decedent has not signed a document of gift, and if the person proposing to

make an anatomical gift knows of any refusal or any contrary indications by the decedent; or

      (3) The person proposing to make an anatomical gift knows of an objection to making an

anatomical gift by a member of the person's same class or a prior class.

      (c) An anatomical gift by a person authorized under subsection (a) must be made by:

      (1) A document of gifts signed by the person or

      (2) The person's telegraphic, recorded telephonic, or other recorded message, or other

form of communication from the person that is contemporaneously reduced to writing and signed

by the recipient.

      (d) An anatomical gift by a person authorized under subsection (a) may be revoked by

any member of the same or a prior class before procedures have begun for the removal from the

body of the decedent, the physician, surgeon, technician, or enucleator removing the part.

      (e) A failure to make an anatomical gift under subsection (a) is not an objection to the

making of an anatomical gift.

 

     23-18.6-4. Referral of death and authorization by medical examiner. -- (a) The

medical examiner or his or her designee shall provide the federally designated organ procurement

organization and other nonprofit federally registered eye and tissue banks, in a timely manner, all

information necessary to facilitate organ and tissue donation including, but not limited to, names

and available contact information of individuals whose deaths have been reported to the medical

examiner's office and jurisdiction accepted.

      (b) The medical examiner may release and permit the removal of a part from a body

within that official's custody, for transplantation or therapy, if:

      (1) The official has received a request for the part from a hospital, physician, surgeon, or

procurement organization;

      (2) A donation has been authorized in accordance with section 23-18.6-2 or 23-18.6-3;

      (3) The official does not know of a refusal or contrary indication by the decedent or

objection by a person having authority to act as listed in section 23-18.6-3(a);

      (4) The removal will be by a physician, surgeon, or technician; but in the case of eyes,

by one of them or by an enucleator;

      (5) The removal will not interfere with any autopsy, investigation, procedure, or other

additional activity as deemed necessary by the medical examiner required to arrive at a

reasonable cause and manner of death;

      (6) The removal will be in accordance with accepted medical standards; and

      (7) Cosmetic restoration will be done, if appropriate.

      (c) The medical examiner, or his or her designee, may permit the removal of the

anatomical gift to occur at the medical examiner's office.

      (d) A permanent record of the names of the decedent, the person making the request, the

date and purpose of the request, the part requested, and the person to whom it was released should

be made by the hospital/physician/technician (enucleator) and forwarded to the medical examiner

for his or her records.

      (e) The medical examiner, or his or her designee, shall be present during the removal of

the anatomical gift if in his or her judgment such attendance would, in the opinion of the medical

examiner or his or her designee, facilitate a donation that would otherwise be denied.

      (f) The medical examiner, or his or her designee, may only deny removal of the

anatomical gift after explaining in writing or verbally with subsequent written documentation to

the federally designated organ procurement organization and other nonprofit federally registered

eye and tissue banks, reasons for determining that those tissues or organs may be involved in the

cause of death.

 

     23-18.6-5. Routine inquiry and required request -- Search and notification. -- (a)

When, in the opinion of the attending physician or other competent medical personnel that the

death of any patient is imminent or has occurred, a representative designated by the hospital

administration shall notify the federally designated organ/tissue procurement organization of

pending death. Except in cases in which the patient is obviously unsuited for donorship, a

discussion of possible donation of organs/tissues shall take place according to medical criteria

established by the federally designated organ/tissue procurement organization and documentation

of notification and resultant options shall take place in the patient's medical record. The hospital

administration shall actively support the education of all appropriate hospital personnel

concerning organ and tissue donation on a regular basis, and shall take all steps necessary to

assure full compliance with this chapter. The federally approved organ procurement organization

shall from time to time be asked to render opinion to the state hospital authority as to the

adequacy of hospital efforts in this area.

      (b) If, at or near the time of death of a patient, there is no medical record that the patient

has made or refused to make an anatomical gift, the hospital administrator or a representative

designated by the administrator shall discuss the option to make or refuse to make an anatomical

gift and request the making of an anatomical gift pursuant to section 23-18.6-3(a). The request

must be made with reasonable discretion and sensitivity to the circumstances of the family. A

request is not required if the gift is not suitable, based upon accepted medical standards,

established by the federally designated organ/tissue procurement agency, for a purpose specified

in section 23-18.6-6. An entry must be made in the medical record of the patient, stating the name

and affiliation of the individual making the request, and of the name, response, reason for not

asking the next of kin or designee, and relationship to the patient of the person to whom the

request was made. The director of the department of health in conjunction with the federally

designated organ/tissue procurement organization shall adopt regulations to implement this

subsection.

      (c) The following persons shall make a reasonable search for a document of gift or other

information identifying the bearer as a donor or as an individual who has refused to make an

anatomical gift:

      (1) A law enforcement officer, fireman, paramedic, or other emergency rescuer finding

an individual who the searcher believes is dead or near death; and

      (2) A hospital, upon the admission of an individual at or near the time of death, if there is

not immediately available any other source of that information.

      (d) If a document of gift or evidence of refusal to make an anatomical gift is located by

the search required by subsection (c)(1), and the individual or body to whom it relates is taken to

a hospital, the hospital must be notified of the contents and the document or other evidence must

be sent to the hospital.

      (e) If, at or near the time of death of a patient, a hospital knows that an anatomical gift

has been made pursuant to section 23-18.6-3(a) of a release and removal of a part has been

permitted pursuant to section 23-18.6-4, or that a patient or an individual identified as in transit to

the hospital is a donor, the hospital shall notify the donee. The hospital shall cooperate in the

implementation of the anatomical gift or release and removal of a part.

      (f) A person who fails to discharge the duties imposed by this section is not subject to

criminal or civil liability but is subject to appropriate administrative sanctions.

      (g) Each hospital shall develop a protocol for addressing the issue of organ and tissue

donation whenever a death occurs in a hospital and the intention of the deceased is unknown. The

protocol shall require that any deceased individual's next of kin or other individual, as specified in

section 23-18.6-2, shall be informed of the option to donate organs and tissue pursuant to chapter

18 of this title for any purpose specified in section 23-18.6-3. The protocol shall encourage

reasonable discretion and sensitivity to the family circumstances in all discussions regarding

donations of tissue or organs and may take into account the deceased individual's religious beliefs

or obvious non-suitability for organ and tissue donation in determining whether or not to make

the request.

      (h) The protocol shall require documentation of the request in the decedent's medical

record and, if no request has been made, of the reasons no request has been made. Whether or not

consent is granted, the statement shall indicate the name of the person granting or refusing the

consent and his or her relationship to the decedent.

      (i) Each hospital shall submit a copy of the protocol to the department of health.

 

     23-18.6-6. Persons who may become donees -- Purposes for which anatomical gifts

may be made. -- (a) The following persons may become donees of anatomical gifts for the

purposes stated:

      (1) A hospital, physician, surgeon, or federally designated organissue procurement

organization, for transplantation, therapy, medical or dental education, research, or advancement

of medical or dental science;

      (2) An accredited medical or dental school, college, or university for education, research,

advancement of medical or dental science; or

      (3) A designated individual for transplantation or therapy needed by that individual.

      (b) An anatomical gift may be made to a designated donee in the case of living related

donor degrees onee or donation of entire body to a medical school for research prior to and well

in advance of death. If a donee is not designated or if the donee is not available or rejects the

anatomical gift, the anatomical gift may be accepted by any hospital.

      (c) If the donee knows of the decedent's refusal or contrary indications to make an

anatomical gift or that an anatomical gift by a member of a class having priority to act is opposed

by a member of the same class or a prior class under section 23-18.6-3(a), the donee may not

accept the anatomical gift.

 

     23-18.6-7. Delivery of document of gift. -- (a) Delivery of a document of gift during the

donor's lifetime is not required for the validity of an anatomical gift.

      (b) If an anatomical gift is made to a designated donee, the document of gift, or a copy,

may be delivered to the donee to expedite the appropriate procedures at the time of death.

 

     23-18.6-8. Rights and duties at death. -- (a) Rights of a donee created by an anatomical

gift are superior to rights of others except with respect to autopsies under section 23-18.6-11(b).

A donee may accept or reject an anatomical gift. If a donee accepts an anatomical gift of an entire

body, the donee, subject to the terms of the gift, may allow embalming and use of the body in

funeral services. If the gift is of a part of a body, the donee, upon the death of the donor and

before embalming, shall cause the part to be removed without unnecessary mutilation. After

removal of the part, custody of the remainder of the body vests in the person under obligation to

dispose of the body.

      (b) The time of death must be determined by a physician or surgeon who attends the

donor at death or, if none, the physician or surgeon who certifies the death. Neither the physician

or surgeon who attends the donor at death nor the physician or surgeon who determines the time

of death may participate in the procedures for removing or transplanting a part unless the

document of gift designates a particular physician or surgeon pursuant to section 23-18.6-2(d).

      (c) If there has been an anatomical gift, a technician may remove any donated parts and

an enucleator may remove any donated eyes or parts of eyes, after determination of death by a

physician or surgeon.

 

     23-18.6-9. Coordination of procurement and use. -- Each hospital in this state shall

establish agreements or affiliations with the federally designated organ/tissue procurement

organization for coordination of procurement and use of human bodies and parts.

 

     23-18.6-10. Sale or purchase of parts prohibited. -- (a) A person may not knowingly,

for valuable consideration, purchase or sell a part for transplantation or therapy, if removal of the

part is intended to occur after the death of the decedent.

      (b) Valuable consideration does not include reasonable payment for the removal,

processing, disposal, preservation, quality control, storage, transportation, or implantation of a

part.

      (c) A person who violates this section is guilty of a felony and upon conviction is subject

to a fine not exceeding fifty thousand dollars ($50,000) or imprisonment not exceeding five (5)

years, or both.

 

     23-18.6-11. Examination, autopsy, liability. -- (a) An anatomical gift authorizes any

reasonable examination necessary to assure medical acceptability of the gift for the purposes

intended.

      (b) The provisions of this chapter are subject to the laws of this state governing

autopsies.

      (c) A hospital, physician, surgeon, medical examiner, local public health officer,

enucleator, technician, or other person, who acts in accordance with this chapter or with the

applicable anatomical gift law of another state or a foreign country or attempt in good faith to do

so is not liable for that act in a civil action or criminal proceeding.

      (d) An individual who makes an anatomical gift pursuant to section 23-18.6-2 or 23-

18.6-3 and the individual's estate are not liable for any injury or damage that may result from the

making or the use of the anatomical gift.

 

     23-18.6-12. Acquired immune deficiency syndrome testing. -- Prior to any organ,

tissue, or part of a human body being transplanted in any human being, the donor shall be tested

for the presence of antibodies to the probable causative agent for acquired immune deficiency

syndrome (AIDS), provided that this condition shall not apply if there is a bona fide

documentable medical emergency which endangers the life of any person. If the test for the

presence of the antibodies is positive, the organ, tissue, or body part shall not be used.

 

     23-18.6-13. Transitional provisions. -- This chapter applies to a document of gift,

revocation, or refusal to make an anatomical gift signed by the donor or a person authorized to

make or object to making an anatomical gift before, on, or after July 1, 1989.

 

     23-18.6-14. Uniformity of application and construction. -- This chapter shall be

applied and construed to effectuate its general purpose to make uniform the law with respect to

the subject of this chapter among states enacting it.

 

     23-18.6-15. Severability. -- If any provision of this chapter or its application to any

person or circumstance is held invalid, the invalidity does not affect other provisions or

application of this chapter which can be given effect without the invalid provision or application,

and to this end the provisions of this chapter are severable.

 

     SECTION 2. Title 23 of the General Laws entitled "HEALTH AND SAFETY" is hereby

amended by adding thereto the following chapter:

 

     CHAPTER 18.6.1

REVISED UNIFORM ANATOMICAL GIFT ACT

 

     23-18.6.1-1. Short title. – This chapter shall be known and may be cited as "The

Maureen A. Sebastianelli and Daniel B. Miller Uniform Anatomical Gift Act."

 

     23-18.6.1-2. Definitions. – For purposes of this chapter, unless the context otherwise

requires:

     (1) “Adult” means an individual who is at least eighteen (18) years of age.

     (2) “Agent” means an individual:

     (i) authorized to make health care decisions on the principal’s behalf by a power of

attorney for health care; or

     (ii) expressly authorized to make an anatomical gift on the principal’s behalf by any other

     record signed by the principal.

     (3) “Anatomical gift” means a donation of all or part of a human body to take effect after

the donor’s death for the purpose of transplantation, therapy, research, or education.

     (4) “Decedent” means a deceased individual whose body or part is or may be the source

of an anatomical gift. The term includes a stillborn infant and, subject to restrictions imposed by

law other than this chapter, a fetus.

     (5) “Disinterested witness” means a witness other than the spouse, child, parent, sibling,

grandchild, grandparent, or guardian of the individual who makes, amends, revokes, or refuses to

make an anatomical gift, or another adult who exhibited special care and concern for the

individual. The term does not include a person to which an anatomical gift could pass under

section 11.

     (6) “Document of gift” means inclusion in a donor registry, a donor card or other record

used to make an anatomical gift. The term includes a statement or symbol on a driver’s license or

identification card.

     (7) “Donor” means an individual whose body or part is the subject of an anatomical gift.

     (8) “Donor registry” means the Rhode Island Donor Registry established under section

31-10-26.1 as well as any other electronic database that identifies donors and complies with

section 23-18.6.1-20.

     (9) “Driver’s license” means a motor vehicle or chauffeurs license or permit issued by the

department of motor vehicles, whether or not conditions are attached to the license or permit.

     (10) “Eye bank” means a person that is licensed, accredited, or regulated under federal or

state law to engage in the recovery, screening, testing, processing, storage, or distribution of

human eyes or portions of human eyes.

     (11) “Guardian” means a person appointed by a court to make decisions regarding the

support, care, education, health, or welfare of an individual. The term does not include a guardian

ad litem.

     (12) “Hospital” means a facility licensed as a hospital under the law of any state or a

facility operated as a hospital by the United States, a state, or a subdivision of a state.

     (13) “Identification card” means an identification card issued by the department of motor

vehicles.

     (14) “Know” means to have actual knowledge.

     (15) “Minor” means an individual who is under eighteen (18) years of age.

     (16) “Organ procurement organization” means a person designated by the Secretary of

the United States Department of Health and Human Services as an organ procurement

organization.

     (17) “Parent” means a parent whose parental rights have not been terminated.

     (18) “Part” means an organ, an eye, or tissue of a human being. The term does not

include the whole body.

     (19) “Person” means an individual, corporation, business trust, estate, trust, partnership,

limited liability company, association, joint venture, public corporation, government or

governmental subdivision, agency, or instrumentality, or any other legal or commercial entity.

     (20) “Physician” means an individual authorized to practice medicine or osteopathy

under the law of any state.

     (21) “Procurement organization” means an eye bank, organ procurement organization, or

tissue bank.

     (22) “Prospective donor” means an individual who is dead or near death and has been

determined by a procurement organization to have a part that could be medically suitable for

transplantation, therapy, research, or education. The term does not include an individual who has

made a refusal that is known by the procurement organization.

     (23) “Reasonably available” means able to be contacted by a procurement organization

without undue effort and willing and able to act in a timely manner consistent with existing

medical criteria necessary for the making of an anatomical gift.

     (24) “Recipient” means an individual into whose body a decedent’s part has been or is

intended to be transplanted.

     (25) “Record” means information that is inscribed on a tangible medium or that is stored

in an electronic or other medium and is retrievable in perceivable form.

     (26) “Refusal” means a record created under section 7 that expressly states an intent to

bar other persons from making an anatomical gift of an individual’s body or part.

     (27) “Sign” means, with the present intent to authenticate or adopt a record:

     (i) to execute or adopt a tangible symbol; or

     (ii) to attach to or logically associate with the record an electronic symbol, sound, or

process.

     (28) “State” means a state of the United States, the District of Columbia, Puerto Rico, the

United States Virgin Islands, or any territory or insular possession subject to the jurisdiction of

the United States.

     (29) “Technician” means an individual determined to be qualified to remove or process

parts by an appropriate organization that is licensed, accredited, or regulated under federal or state

law. The term includes an enucleator.

     (30) “Tissue” means a portion of the human body other than an organ or an eye. The term

does not include blood unless the blood is donated for the purpose of research or education.

     (31) “Tissue bank” means a person that is licensed, accredited, or regulated under federal

or state law to engage in the recovery, screening, testing, processing, storage, or distribution of

tissue.

     (32) “Transplant hospital” means a hospital that furnishes organ transplants and other

medical and surgical specialty services required for the care of transplant patients.

 

     23-18.6.1-3. Applicability. – This chapter applies to an anatomical gift or amendment to,

revocation of, or refusal to make an anatomical gift, whenever made.

 

     23-18.6.1-4. Who may make anatomical gift before donor's death. -- Subject to the

provisions of this chapter, an anatomical gift of a donor’s body or part may be made during the

life of the donor for the purpose of transplantation, therapy, research, or education by:

     (1) the donor, if the donor is an adult or if the donor is a minor and is:

     (i) emancipated; or

     (ii) authorized under state law to apply for a driver’s license because the donor is at least

sixteen (16) years of age;

     (2) an agent of the donor, unless the power of attorney for health care or other record

prohibits the agent from making an anatomical gift;

     (3) a parent of the donor, if the donor is an unemancipated minor; or

     (4) the donor’s guardian.

 

     23-18.6.1-5. Manner of making anatomical gift before donor's death. -- (a) A donor

may make an anatomical gift:

     (1) by authorizing a statement or symbol indicating that the donor has made an

anatomical gift to be imprinted on the donor’s driver’s license or identification card;

     (2) in a will;

     (3) during a terminal illness or injury of the donor, by any form of communication

addressed to at least two (2) adults, at least one of whom is a disinterested witness; or

     (4) as provided in subsection (b).

     (b) A donor or other person authorized to make an anatomical gift under this chapter may

make a gift by authorizing inclusion of the donor on a donor registry, a donor card or other record

signed by the donor or other person making the gift. If the donor or other person is physically

unable to sign a record, the record may be signed by another individual at the direction of the

donor or other person and must:

     (1) be witnessed by at least two (2) adults, at least one of whom is a disinterested witness,

who have signed at the request of the donor or the other person; and

     (2) state that it has been signed and witnessed as provided in paragraph (1).

     (c) Revocation, suspension, expiration, or cancellation of a driver’s license or

identification card upon which an anatomical gift is indicated does not invalidate the gift.

     (d) An anatomical gift made by will takes effect upon the donor’s death whether or not

the will is probated. Invalidation of the will after the donor’s death does not invalidate the gift.

 

     23-18.6.1-6. Amending or revoking anatomical gift before donor's death. -- (a)

Subject to the provisions of this chapter, a donor or other person authorized to make an

anatomical gift may amend or revoke an anatomical gift by:

     (1) a record signed by:

     (i) the donor;

     (ii) the other person so authorized; or

     (iii) subject to subsection (b), another individual acting at the direction of the donor or the

other person so authorized if the donor or other person is physically unable to sign; or

     (2) a later-executed document of gift that amends or revokes a previous anatomical gift or

portion of an anatomical gift, either expressly or by inconsistency.

     (b) A record signed pursuant to paragraph (a)(1)(iii) must:

     (1) be witnessed by at least two (2) adults, at least one of whom is a disinterested witness,

who have signed at the request of the donor or the other person; and

     (2) state that it has been signed and witnessed as provided in subdivision (1).

     (c) Subject to the provisions of this chapter, a donor or other person authorized to make

an anatomical gift may revoke an anatomical gift by the destruction or cancellation of the

document of gift, or the portion of the document of gift used to make the gift, with the intent to

revoke the gift.

     (d) A donor may amend or revoke an anatomical gift that was not made in a will by any

form of communication during a terminal illness or injury addressed to at least two (2) adults, at

least one of whom is a disinterested witness.

     (e) A donor who makes an anatomical gift in a will may amend or revoke the gift in the

manner provided for amendment or revocation of wills or as provided in this chapter.

 

     23-18.6.1-7. Refusal to make anatomical gift – Effect of refusal. -- (a) An individual

may refuse to make an anatomical gift of the individual’s body or part by:

     (1) a record signed by:

     (i) the individual; or

     (ii) subject to subsection (b), another individual acting at the direction of the individual if

the individual is physically unable to sign;

     (2) the individual’s will, whether or not the will is admitted to probate or invalidated after

the individual’s death; or

     (3) any form of communication made by the individual during the individual’s terminal

illness or injury addressed to at least two (2) adults, at least one of whom is a disinterested

witness.

     (b) A record signed pursuant to paragraph (a)(1)(ii) must:

     (1) be witnessed by at least two (2) adults, at least one of whom is a disinterested witness,

who have signed at the request of the individual; and

     (2) state that it has been signed and witnessed as provided in paragraph (1).

     (c) An individual who has made a refusal may amend or revoke the refusal:

     (1) in the manner provided in subsection (a) for making a refusal;

     (2) by subsequently making an anatomical gift pursuant to the provisions of this chapter

that is inconsistent with the refusal; or

     (3) by destroying or canceling the record evidencing the refusal, or the portion of the

record used to make the refusal, with the intent to revoke the refusal.

     (d) Except as otherwise provided in this chapter, in the absence of an express, contrary

indication by the individual set forth in the refusal, an individual’s unrevoked refusal to make an

anatomical gift of the individual’s body or part bars all other persons from making an anatomical

gift of the individual’s body or part.

 

     23-18.6.1-8. Preclusive effect of anatomical gift, amendment or revocation. -- (a)

Except as otherwise provided in this section, in the absence of an express, contrary indication by

the donor, a person other than the donor is barred from making, amending, or revoking an

anatomical gift of a donor’s body or part if the donor made an anatomical gift of the donor’s body

or part in accordance with the provisions of this chapter.

     (b) A donor’s revocation of an anatomical gift of the donor’s body or part shall not be a

refusal and does not bar another authorized person specified in this chapter from making an

anatomical gift of the donor’s body or part.

     (c) If a person other than the donor makes an unrevoked anatomical gift of the donor’s

body or part, or an amendment to an anatomical gift of the donor’s body or part, another person

may not make, amend, or revoke the gift of the donor’s body or part under the provisions of this

chapter.

     (d) A revocation of an anatomical gift of a donor’s body or part by a person other than the

donor does not bar another person from making an anatomical gift of the body or part under the

provisions of this chapter.

     (e) In the absence of an express, contrary indication by the donor or other person

authorized to make an anatomical gift in accordance with this chapter, an anatomical gift of a part

is neither a refusal to give another part nor a limitation on the making of an anatomical gift of

another part at a later time by the donor or another person.

     (f) In the absence of an express, contrary indication by the donor or other person

authorized to make an anatomical gift in accordance with this chapter, an anatomical gift of a part

for one or more of the purposes set forth in section 23-18.6.1-4 is not a limitation on the making

of an anatomical gift of the part for any of the other purposes by the donor or any other person

under the provisions of this chapter.

     (g) If a donor who is an unemancipated minor dies, a parent of the donor who is

reasonably available may revoke or amend an anatomical gift of the donor’s body or part.

     (h) If an unemancipated minor who signed a refusal dies, a parent of the minor who is

reasonably available may revoke the minor’s refusal.

 

     23-18.6.1-9. Who may make anatomical gift of decedent's body or part. -- (a) Subject

to subsections (b) and (c) and unless barred by this chapter, an anatomical gift of a decedent’s

body or part for purpose of transplantation, therapy, research, or education may be made by any

member of the following classes of persons who is reasonably available, in the order of priority

listed:

     (1) an agent of the decedent at the time of death who could have made an anatomical gift

pursuant to this chapter immediately before the decedent’s death;

     (2) the spouse of the decedent or the certified domestic partner of the decedent as defined

in subsections 36-12-1(3) and 45-19-4.3(b) or any other provision of state law;

     (3) adult children of the decedent;

     (4) parents of the decedent;

     (5) adult siblings of the decedent;

     (6) adult grandchildren of the decedent;

     (7) grandparents of the decedent;

     (8) an adult who exhibited special care and concern for the decedent, who is familiar with

the decedent’s personal values, and who had maintained regular contact with the decedent prior to

his or her death; provided, however, it shall not include any medical personnel caring for the

decedent at the time of or immediately leading up to the decedent’s death; and

     (9) the persons who were acting as the guardians of the person of the decedent at the time

of death.

     (b) If there is more than one member of a class listed in the previous subsection which is

entitled to make an anatomical gift, an anatomical gift may be made by a member of the class

unless that member or a person to which the gift may pass under the provisions of this chapter

knows of an objection by another member of the class. If an objection is known, the gift may be

made only by a majority of the members of the class who are reasonably available.

     (c) 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.

 

     23-18.6.1-10. Manner of making, amending or revoking anatomical gift of

decedent's body or part. -- (a) A person authorized to make an anatomical gift under section 23­

18.6.1-9 may make an anatomical gift by a document of gift signed by the person making the gift

or by that person’s oral communication that is electronically recorded or is contemporaneously

reduced to a record and signed by the individual receiving the oral communication.

     (b) Subject to subsection (c), an anatomical gift by a person authorized under section 23­

18.6.1-9 may be amended or revoked orally or in a record by any member of a prior class who is

reasonably available. If more than one member of the prior class is reasonably available, the gift

made by a person authorized under section 23-18.6.1-9 may be:

     (1) amended only if a majority of the reasonably available members agree to the

amending of the gift; or

     (2) revoked only if a majority of the reasonably available members agree to the revoking

of the gift or if they are equally divided as to whether to revoke the gift.

     (c) A revocation under subsection (b) is effective only if, before an incision has been

made to remove a part from the donor’s body or before invasive procedures have begun to

prepare the recipient, the procurement organization, transplant hospital, or physician or technician

knows of the revocation.

 

     23-18.6.1-11. Persons that may receive anatomical gift – purpose of anatomical gift. -

­- (a) An anatomical gift may be made to the following persons named in the document of gift:

     (1) a hospital; accredited medical school, dental school, college, or university; organ

procurement organization; or other appropriate person, for research or education;

     (2) subject to subsection (b), an individual designated by the person making the

anatomical gift if the individual is the recipient of the part;

     (3) an eye bank or tissue bank.

     (b) If an anatomical gift to an individual under subdivision (a)(2) cannot be transplanted

into the individual, the part passes in accordance with subsection (g) in the absence of a known,

express, contrary indication by the person making the anatomical gift.

     (c) If an anatomical gift of one or more specific parts or of all parts is made in a

document of gift that does not name a person described in subsection (a) but identifies the

purpose for which an anatomical gift may be used, the following rules apply:

     (1) If the part is an eye and the gift is for the purpose of transplantation or therapy, the

gift passes to the appropriate eye bank.

     (2) If the part is tissue and the gift is for the purpose of transplantation or therapy, the gift

passes to the appropriate tissue bank.

     (3) If the part is an organ and the gift is for the purpose of transplantation or therapy, the

gift passes to the appropriate organ procurement organization as custodian of the organ.

     (4) If the part is an organ, an eye, or tissue and the gift is for the purpose of research or

education, the gift passes to the appropriate procurement organization.

     (d) For the purpose of subsection (c), if there is more than one purpose of an anatomical

gift set forth in the document of gift but the purposes are not set forth in any priority, the gift must

be used for transplantation or therapy, if suitable. If the gift cannot be used for transplantation or

therapy, the gift may be used for research or education.

     (e) If an anatomical gift of one or more specific parts is made in a document of gift that

does not name a person described in subsection (a) and does not identify the purpose of the gift,

the gift passes in accordance with subsection (g) and must be used for transplantation or therapy,

if suitable. If the gift cannot be used for transplantation or therapy, the gift may be used for

research or education.

     (f) If a document of gift specifies only a general intent to make an anatomical gift by

words such as “donor”, “organ donor”, or “body donor”, or by a symbol or statement of similar

import, the gift passes in accordance with subsection (g) and must be used for transplantation or

therapy, if suitable. If the gift cannot be used for transplantation or therapy, the gift may be used

for research or education.

     (g) For purposes of subsections (b), (e), and (f) the following rules apply:

     (1) If the part is an eye, the gift passes to the appropriate eye bank.

     (2) If the part is tissue, the gift passes to the appropriate tissue bank.

     (3) If the part is an organ, the gift passes to the appropriate organ procurement

organization as custodian of the organ.

     (h) An anatomical gift of an organ for transplantation or therapy, other than an

anatomical gift under subdivision (a)(2), passes to the organ procurement organization as

custodian of the organ.

     (i) If an anatomical gift does not pass pursuant to subsections (a) through (h) or the

decedent’s body or part is not used for transplantation, therapy, research, or education, custody of

the body or part passes to the person under obligation to dispose of the body or part.

     (j) A person may not accept an anatomical gift if the person knows that the gift was not

effectively made in accordance with this chapter or if the person knows that the decedent made a

refusal in accordance with this chapter that was not revoked. For purposes of the subsection, if a

person knows that an anatomical gift was made on a document of gift, the person is deemed to

know of any amendment or revocation of the gift or any refusal to make an anatomical gift on the

same document of gift.

     (k) Except as otherwise provided in subdivision (a)(2), nothing in this chapter affects the

allocation of organs for transplantation or therapy.

 

     23-18.6.1-12. Search and notification. -- (a) The following persons shall make a

reasonable search of an individual who the person reasonably believes is dead or near death for a

document of gift or other information identifying the individual as a donor or as an individual

who made a refusal:

     (1) a law enforcement officer, firefighter, paramedic, or other emergency rescuer finding

the individual; and

     (2) if no other source of the information is immediately available, a hospital, as soon as

practical after the individual’s arrival at the hospital.

     (b) If a document of gift or a refusal to make an anatomical gift is located by the search

required by subdivision (a)(1) and the individual or deceased individual to whom it relates is

taken to a hospital, the person responsible for conducting the search shall send the document of

gift or refusal to the hospital.

     (c) A person is not subject to criminal or civil liability for failing to discharge the duties

imposed by this section but may be subject to administrative sanctions.

 

     23-18.6.1-13. Delivery of document of gift not required – Right to examine. -- (a) A

document of gift need not be delivered during the donor’s lifetime to be effective.

     (b) Upon or after an individual’s death, a person in possession of a document of gift or a

refusal to make an anatomical gift with respect to the individual shall allow examination and

copying of the document of gift or refusal by a person authorized to make or object to the making

of an anatomical gift with respect to the individual or by a person to which the gift could pass

pursuant to the provisions of this chapter.

 

     23-18.6.1-14. Rights and duties of procurement organization and others. -- (a) When

a hospital refers an individual at or near death to a procurement organization, the organization

shall make a reasonable search of the records of the department of motor vehicles and any donor

registry that it knows exists for the geographical area in which the individual resides to ascertain

whether the individual has made an anatomical gift.

     (b) A procurement organization must be allowed reasonable access to information in the

records of the Rhode Island Donor Registry to ascertain whether an individual at or near death is

a donor.

     (c) When a hospital refers an individual at or near death to a procurement organization,

the organization may conduct any reasonable examination necessary to assess the medical

suitability of a part that is or could be the subject of an anatomical gift for transplantation,

therapy, research, or education from a donor or a prospective donor. During the examination

period, measures necessary to maintain the potential medical suitability of the part may not be

withdrawn unless the hospital or procurement organization knows that the individual expressed a

contrary intent.

     (d) Unless otherwise prohibited, at any time after a donor’s death, the person to which a

part passes under this chapter may conduct any reasonable examination necessary to assess the

medical suitability of the body or part for its intended purpose.

     (e) Unless otherwise prohibited, an examination under subsection (c) or (d) may include

an examination of all medical and dental records of the donor or prospective donor.

     (f) Upon the death of a minor who was a donor or had signed a refusal, unless a

procurement organization knows the minor is emancipated, the procurement organization shall

conduct a reasonable search for the parents of the minor and provide the parents with an

opportunity to revoke or amend the anatomical gift or revoke the refusal.

     (g) Upon referral by a hospital under subsection (a), a procurement organization shall

make a reasonable search for any person listed in section 23-18.6.1-9 having priority to make an

anatomical gift on behalf of a prospective donor. If a procurement organization receives

information that an anatomical gift to any other person was made, amended, or revoked, it shall

promptly advise the other person of all relevant information.

     (h) Subject to the provisions of this chapter, the rights of the person to which a part

passes under section 23-18.6.1-11 are superior to the rights of all others with respect to the part.

The person may accept or reject an anatomical gift in whole or in part. Subject to the terms of the

document of gift as specified in this chapter, a person that accepts an anatomical gift of an entire

body may allow embalming, burial or cremation, and use of remains in a funeral service. If the

gift is of a part, the person to which the part passes under section 23-18.6.1-11, upon the death of

the donor and before embalming, burial, or cremation, shall cause the part to be removed without

unnecessary mutilation.

     (i) Neither the physician who attends the decedent at death nor the physician who

determines the time of the decedent’s death may participate in the procedures for removing or

transplanting a part from the decedent.

     (j) A physician or technician may remove a donated part from the body of a donor that

the physician or technician is qualified to remove.

 

     23-18.6.1-15. Coordination of procurement and use. -- Each hospital in this state shall

enter into agreements or affiliations with procurement organizations for coordination of

procurement and use of anatomical gifts.

 

     23-18.6.1-16. Sale or purchase of parts prohibited. -- (a) Except as otherwise provided

in subsection (b), a person that for valuable consideration, knowingly purchases or sells a part for

transplantation or therapy if removal of a part from an individual is intended to occur after the

individual’s death commits a felony and upon conviction is subject to a fine not exceeding fifty

thousand dollars ($50,000) or imprisonment not exceeding five (five) years, or both.

     (b) A person may charge a reasonable amount for the removal, processing, preservation,

quality control, storage, transportation, implantation, or disposal of a part.

 

     23-18.6.1-17. Other prohibited acts. -- A person that, in order to obtain a financial gain,

intentionally falsifies, forges, conceals, defaces, or obliterates a document of gift, an amendment

or revocation of a document of gift, or a refusal commits a felony and upon conviction is subject

to a fine not exceeding fifty thousand dollars ($50,000) or imprisonment not exceeding five (5)

years, or both.

 

     23-18.6.1-18. Immunity. -- (a) A person that acts in accordance with this chapter or with

the applicable anatomical gift law of another state, or attempts in good faith to do so, is not liable

for the act in a civil action, criminal prosecution, or administrative proceeding.

     (b) Neither the person making an anatomical gift nor the donor’s estate is liable for any

injury or damage that results from the making or use of the gift.

     (c) In determining whether an anatomical gift has been made, amended, or revoked

pursuant to this chapter, a person may rely upon representations of an individual listed in section

23-18.6.1-9 relating to the individual’s relationship to the donor or prospective donor unless the

person knows that the representation is untrue.

 

     23-18.6.1-19. Law governing validity – Choice of law as to execution of document of

gift – Presumption of validity. --(a) A document of gift is valid if executed in accordance with:

     (1) this chapter;

     (2) the laws of the state where it was executed; or

     (3) the laws of the state where the person making the anatomical gift was domiciled, has

a place of residence, or was a national at the time the document of gift was executed.

     (b) If a document of gift is valid under this section, the law of this state governs the

interpretation of the document of gift.

     (c) A person may presume that a document of gift or amendment of an anatomical gift is

valid unless that person knows that it was not validly executed or was revoked.

 

     23-18.6.1-20. Donor registry. -- (a) A donor registry must:

     (1) allow a donor or other person authorized pursuant to this chapter to include an

individual on the donor registry who has made an anatomical gift;

     (2) be accessible to a procurement organization to allow it to obtain relevant information

on the donor registry to determine, at or near death of the donor or a prospective donor, whether

the donor or prospective donor has made an anatomical gift; and

     (3) be accessible for purposes of subdivisions (1) and (2) seven days a week on a twenty-

four (24) hour basis.

     (b) Personally identifiable information on a donor registry about a donor or prospective

donor may not be used or disclosed without the express consent of the donor, prospective donor,

or person that made the anatomical gift for any purpose other than to determine, at or near death

of the donor or prospective donor, whether the donor or prospective donor has made an

anatomical gift.

 

     23-18.6.1-21. [reserved].

 

     23-18.6.1-22. Cooperation between medical examiner and procurement

organization. -- A medical examiner shall cooperate with procurement organizations to

maximize the opportunity to recover anatomical gifts for the purpose of transplantation, therapy,

research, or education.

 

     23-18.6.1-23. Facilitation of anatomical gift from decedent whose body is under

jurisdiction of medical examiner. – (a) The medical examiner or his or her designee shall

provide the federally designated organ procurement organization and other nonprofit federally

registered eye and tissue banks, in a timely manner, all information necessary to facilitate organ

and tissue donation including, but not limited to, names and available contact information of

individuals whose deaths have been reported to the medical examiner's office and jurisdiction

accepted.

     (b) The medical examiner may release and permit the removal of a part from a body

within that official's custody, for transplantation or therapy, if:

     (1) The official has received a request for the part from a hospital, physician, surgeon, or

procurement organization;

     (2) A donation has been authorized in accordance with sections 23-18.6.1-5 or 23-18.6.1-

9;

     (3) The official does not know of a refusal or contrary indication by the decedent or

objection by a person having authority to act as listed in section 23-18.6.1-9;

     (4) The removal will be by a physician, surgeon, or technician; but in the case of eyes, by

one of them or by an enucleator;

     (5) The removal will not interfere with any autopsy, investigation, procedure, or other

additional activity as deemed necessary by the medical examiner required to arrive at a

reasonable cause and manner of death;

     (6) The removal will be in accordance with accepted medical standards; and

     (7) Cosmetic restoration will be done, if appropriate.

     (c) The medical examiner, or his or her designee, may permit the removal of the

anatomical gift to occur at the medical examiner's office.

     (d) A permanent record of the names of the decedent, the person making the request, the

date and purpose of the request, the part requested, and the person to whom it was released should

be made by the hospital/physician/technician (enucleator) and forwarded to the medical examiner

for his or her records.

     (e) The medical examiner, or his or her designee, shall be present during the removal of

the anatomical gift if in his or her judgment such attendance would, in the opinion of the medical

examiner or his or her designee, facilitate a donation that would otherwise be denied.

     (f) The medical examiner, or his or her designee, may only deny removal of the

anatomical gift after explaining in writing or verbally with subsequent written documentation to

the federally designated organ procurement organization and other nonprofit federally registered

eye and tissue banks, reasons for determining that those tissues or organs may be involved in the

cause of death.

 

     23-18.6.1-24. Uniformity of application and construction. -- In applying and

construing this uniform act, consideration must be given to the need to promote uniformity of the

law with respect to its subject matter among states that enact it.

 

     23-18.6.1-25. Relation to electronic signatures in global and national commerce act.

-- This act modifies, limits, and supersedes the Electronic Signatures in Global and National

Commerce Act, 15 U.S.C. Section 7001 et seq., but does not modify, limit or supersede Section

101(a) of that act, 15 U.S.C. Section 7001, or authorize electronic delivery of any of the notices

described in Section 103(b) of that act, 15 U.S.C. Section 7003(b).

 

     SECTION 3. Section 31-10-26.1 of the General Laws in Chapter 31-10 entitled

"Operators' and Chauffeurs' Licenses" is hereby amended to read as follows:

 

     31-10-26.1. Anatomical gifts by drivers. -- (a) The division of motor vehicles shall

cause to be sent to each person applying for or renewing a license, as provided for in section 31-

10-26, a document containing a summary description and explanation of the Revised Uniform

Anatomical Gift Act, chapter 18.6.1 of title 23.

      (b) The division of motor vehicles may, on behalf of the state accept and deposit with the

general treasurer any grant, gift, or contribution made to assist in meeting the cost of carrying out

the purposes of this section and to expend the grant, gift, or contribution for those purposes.

      (c) The division of motor vehicles may make and sign any agreements and may do and

perform any and all acts which may be necessary or desirable to carry out the purposes of this

section.

      (d) The division of motor vehicles shall issue special licenses upon request of a licensee

which conform to the provisions of the Rhode Island Revised Uniform Anatomical Gift Act,

chapter 18.6.1 of title 23.

      (e) Neither the administrator of the division of motor vehicles nor any employee of the

state shall be liable in any suit for damages as a result of his or her acts or omissions or for any

action under the provisions of this section.

      (f) The division of motor vehicles shall cause to be posted in all of its customer service

locations a sign or other material encouraging persons to make anatomical gifts during the

process of issuing and renewing licenses provided for in section 31-10.1-1 and in accordance

with the Revised Uniform Anatomical Gift Act, chapter 18.6.1 of title 23.

      (g) The division of motor vehicles shall cause to be produced application forms and

renewal forms for driver's licenses and nonoperator identification cards that clearly offer Rhode

Island residents the option to consent to organ and tissue donation in accordance with section 31-

10.1-8. Only a "yes" or affirmative response will be noted. Information held by the division of

motor vehicles regarding a person's consent to donate shall constitute the "Rhode Island Donor

Registry." This information will be made available to all federally designated organ procurement

organizations and law enforcement organizations twenty-four (24) hours a day via a password

protected Internet connection and will only be used to fulfill the donation wishes of the licensee

or card holder. Only a "yes" or affirmative response will be noted. Information held by the

division of motor vehicles regarding a person's consent to donate shall constitute the "Rhode

Island Donor Registry." This information will be made available to all federally designated organ

procurement organizations and law enforcement organizations twenty-four (24) hours a day via a

password protected Internet connection and will only be used to fulfill the donation wishes of the

licensee or card holder facilitate anatomical gifts in accordance with the Revised Uniform

Anatomical Gift Act, chapter 23-18.6.1.

      (h) The division of motor vehicles shall develop by January 1, 2008 a method that

requires written consent and confirmation to allow residents of Rhode Island to have their names

accurately added to or deleted from the division's Rhode Island Donor Registry in the periods

between mandated driver's license renewals. Persons added to the Donor Registry in this manner

shall be considered as having made a document of gift.

 

     SECTION 4. This act shall take effect upon passage.

     

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LC01996/SUB A/3

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