© Copyright May 2018
Given the ongoing opioid crisis, the link between these
Introduction
At least 42,249 Americans died from opioid overdoses in
2016, a 28 percent increase from 2015, according to the
National Center for Health Statistics, a division of the Cen-
ters for Disease Control and Prevention (CDC). Opioids now
kill more Americans each year than guns, breast cancer or
automobile accidents and have contributed to the shorten-
ing of the average U.S. life expectancy for two consecutive
years. The last recorded decrease in U.S. life expectancy
was in 1993, due to the AIDS epidemic. The last time life
expectancy decreased in two consecutive years was in 1962
and 1963 due to an influenza outbreak.1,2
As of early April 2018, approximately 115,000 Americans
were listed on the national organ transplant registry waiting
on a lifesaving organ transplant, with a new person added to
the list every 10 minutes.3 Despite advancements in technol-
ogy and surgical techniques, a large gap remains between the
number of organs needed and the supply of donated organs.
While 95 percent of U.S. adults support organ donation, only
54 percent have enrolled to be organ donors.4 Every day, an
average of 95 organ transplants are performed in the United
States,5 and an average of 20 Americans die daily waiting for
a transplant.6 Contributing to this tragic scenario is the fact
that only three in 1,000 deaths in the United States occur
in a manner conducive to organ donation.7
seemingly disparate issues is an important one. This SLC
Regional Resource raises policy considerations and highlights
the connections between the ongoing opioid crisis and the
national shortage of organs for transplantation. Additionally,
an examination of the history and process of organ donation
and transplants is provided, as well as actions taken by the
federal government and state governments to facilitate and
promote organ donation. A discussion of how the national
opioid crisis, critical to this discussion, is affecting organ
transplant rates is included.
History of Organ Transplantation
While organ transplantation did not become common until
the 1900s, research suggests that doctors and scientists experi-
mented with organ transplantation involving animals and
humans as early as the 1700s.8 At the turn of the 20th
century, European doctors attempted to treat renal failure
by transplanting kidneys from animals—including monkeys,
pigs and goats—into humans. The survival rate, within days
of the surgery, was zero. However, in 1905, Austrian ophthal-
mologist Eduard Zim performed the world’s first successful
corneal transplant, restoring vision to a male patient. In
1936, Ukrainian doctor Yu Yu Voronoy transplanted the first
human kidney from a deceased donor. While the procedure
itself was successful, the recipient passed away shortly after
the surgery due to organ rejection.9
The first successful living organ transplantation surgery*
was performed at Boston’s Brigham Hospital in 1954,
when Dr. Joseph Murray and Dr. David Hume trans-
planted a kidney from a patient to his twin brother.
Another notable breakthrough occurred in 1962, when
Drs. Murray and Hume performed the first successful
transplant surgery involving a deceased donor, transplant-
ing a kidney. In subsequent years, these groundbreaking
surgeries were followed by other milestones. The first
successful heart, pancreas and liver transplants were per-
formed in the 1960s, while the first successful single and
double lung transplants were performed in the 1980s.10,11
The Process of Organ Transplantation
Americans have three ways to affirm their intent to be
an organ donor: 1) registering online with Donate Life
America—a national nonprofit organization that strives to
promote organ donation—at DonateLife.net or a statewide
Donate Life affiliate, 2) enrolling as an organ donor on a
driver’s license or other government-issued identification
card, and/or 3) listing themselves as an organ donor in
a will.12 The existing options are few, and due to the
infrequency of obtaining and renewing a driver’s license
and the inherent issues and timing of executing a will,
the current options become even less expedient.
There are two primary methods of organ procurement:
upon death or as a living donor. Organs that may be
donated by a deceased donor include the heart and heart
valves, lung, liver, kidney, pancreas and intestines, while
a living donor may donate one of two kidneys, one of
two lobes of the liver, part of a lung, part of a pancreas
or part of the intestines.13 For partial donations, the por-
tion removed is not enough to affect organ functionality
of the donor.
Approximately 60 percent of organ donations in the
United States come from a deceased donor.14 Months,
years or even decades after registering to become an organ
donor, an individual may experience a fatal accident or
illness or pass from natural causes. To enable deceased
organ donation, an individual must be declared brain
dead in a hospital while connected to a ventilator to keep
*
A living organ transplant/donation surgery is one in which the
donor is alive at the time of the surgery.
2 OPIOIDS AND ORGAN DONATIONS: A TALE OF TWO CRISES
oxygenated blood flowing through the organ(s), which
occurs only in about three out of every 1,000 deaths in
the United States. The cause of death is an additional
concern. Most patients who are evaluated for organ dona-
tion have experienced a stroke, brain aneurysm, drug
overdose or suffered fatal injuries from a car accident. A
patient is not considered for organ donation until all other
lifesaving procedures have been attempted.15,16,17 After
being declared brain dead by a doctor, a specially trained
representative from an organ procurement organization
(OPO)—a private, nonprofit organization certified by the
Centers for Medicare and Medicaid Services,† working
to increase the number of organ donors and coordinate
the donation process—is dispatched to the hospital to
evaluate the patient’s medical viability.18,19
Next, a representative from the OPO, or specially-trained
hospital staff, talks to the patient’s next-of-kin about the
patient’s desire to be an organ donor.‡ The patient’s medi-
cal information and hospital zip code are entered into
an online database managed by the United Network for
Organ Sharing (UNOS)—a national nonprofit organiza-
tion headquartered in Richmond, Virginia, originally
formed in 1986 as the Southeast Organ Procurement
Foundation—to begin the organ allocation process. Using
the online database, the donor’s organs are matched with
the best possible recipient, considering the donor’s medical
conditions and proximity to the recipient. After the organs
are surgically removed, they are transported to the receiv-
ing hospital(s) and transplanted into the recipient(s).20
Deceased organ donors do not pay for any of the costs
of their donation, including the transplant surgeries or
organ preservation/transportation. These costs are funded
by the transplant recipient, usually through their private
insurance, Medicare or Medicaid.21
The other organ donation method is a living donation,
representing approximately 40 percent of organ dona-
tions. It is a generally accepted principle that living
†
For a list of all 58 OPOs in the nation, please visit: https://www.
organdonor.gov/awareness/organizations/local-opo.html.
‡
In years past, a relative could override the patient’s decision to
donate, but the practice was eliminated by the 2006 Uniform Ana-
tomical Gift Act (UAGA), discussed at greater length on page 7.
SLC REGIONAL RESOURCE
organ donation has no negative effects on the donor,
but research on the topic is limited. However, there are
concerns from some in the medical field that subtle medi-
cal problems could develop over years. Currently, the
National Institutes of Health is conducting a study to
determine if there are any negative effects from making
a living donation.22
The steps of a living organ donation resemble those of
a deceased organ donation, but with two major differ-
ences: 1) living donors may choose their organ recipient,
and 2) the donor may be responsible for some of the
costs associated with their donation (although grants and
tax incentives often are available to cover some of these
costs). The National Living Donor Assistance Center is
a federally funded program under the purview of the
U.S. Department of Health and Human Services (HHS)
that reimburses up to $6,000 of expenses—including
travel, meals and lodging—incurred through the dona-
tion process. To qualify, donors must have household
incomes no greater than 300 percent of the Federal
Poverty Guidelines.23 Additionally, some states offer tax
credits or incentives to living organ donors.
Some patients may experience a waiting time of months
or years to receive a donated organ. The length of time
depends on multiple factors, including:
»» Blood type
»» Tissue type
»» Height and weight of donor and recipient
»» Size of donated organ
»» Medical urgency
»» Time on the organ waiting list
»» Distance between the donor’s hospital and the poten-
tial donor
»» Number of donors in the local area
»» The transplant center’s criteria for accepting donated
organs.24
Furthermore, different organs require varying methods
of preservation, in which the organ is removed from the
patient and flushed with a cooled solution to remove all
blood, to remain viable between removal and transplanta-
tion. For example, a heart or lung will need four to six
SLC REGIONAL RESOURCE
hours of preservation to remain viable, while a kidney
will require 24 to 36 hours of preservation.25,26 After the
organ is preserved, it is placed on ice and transported to
the recipient’s hospital. Transplant teams generally have
less than eight hours to transport the preserved organ.27
Geography and Liver Donation
The United Network for Organ Sharing divides the
United States into 11 geographic regions. When a patient
needs an organ, they are matched with a donor in their
region through the Organ Procurement and Transplan-
tation Network. This system is intended to optimize
the use of donated organs, as a liver is only viable for
approximately eight hours after removal. However, this
system has led to issues, such as a patient not receiving a
donated organ that is nearby, but in another region. Pres-
ently, UNOS is considering revising the system for liver
transplants, such that a patient could be matched with a
donor in their region and one within a 150 nautical-mile
radius (172.6 mile).28,29
Opioids and Organ Donation:
A New Variable in the Equation
Opioids—a class of drugs that works on the opioid recep-
tors in the brain—are used to treat pain and can be habit
forming.* According to the National Institute on Drug
Abuse, a division of the National Institutes of Health,
opioids are considered to be generally safe when taken
for a short time as prescribed by a doctor. However, pre-
scription opioids—including oxycodone, hydrocodone,
codeine and morphine—frequently are sold on the black
market by patients who received legal prescriptions. 30
The national opioid crisis has reached record levels in the
last several years, with at least 42,249 Americans dying
from opioid overdose deaths in 2016, up from 33,091
opioid overdose deaths in 2015.31,32
Fentanyl, a synthetic opioid originally used as an anes-
thetic, has been particularly deadly. The drug—100 times
more potent than morphine and 50 times more potent
than heroin—is identical in appearance to heroin, caus-
ing some users to inadvertently take fentanyl instead of
*
Opioids are distinct from opiates, which are derived from the
opium plant.
OPIOIDS AND ORGAN DONATIONS: A TALE OF TWO CRISES 3
heroin. A lethal dose of heroin is 30 milligrams, while a victims. While an opioid overdose may cause death,
lethal dose of fentanyl is 3 milligrams.33 the drugs often leave organs unharmed.39 Additionally,
the average organ donor who dies from a drug overdose
According to the National Institute on Drug Abuse, the is in their early 30s—approximately 10 years younger
number of prescription opioid overdoses in the United than the average organ donor—with some victims pass-
States increased 340 percent from 2001 to 2014, with ing away after their first dose.40 In the past five years,
the number of heroin overdoses increasing approximately overall organ transplantation rates have been increasing.
600 percent during the same period. Ten years ago, drug
overdoses accounted for 3 percent of the organ donor
population.34 In 2017, 13 percent of organ donations 2016 opioid overdose
came from drug overdoses.35 Table 1
death rates by state
2016 opioid
A recent CDC report cites a 30 percent increase nation- Percent change
State overdose
ally in opioid overdoses from July 2016 to September from 2016
death rate*
2017, with the South experiencing a 14 percent increase.
Alabama 7.4 +23%
While statistics for the year 2017 are not yet available,
analysts expect the crisis to continue. Some experts have Arkansas 5.9 -18%
called for doctors and medical personnel to follow up
Florida 14.4 +53%
with overdose survivors after they have been revived to
help facilitate addiction treatment and recovery as one Georgia 8.8 +5%
method of intervention.36 However, in areas of high opioid Kentucky 23.6 +12%
use, this approach may be logistically challenging. There
is a growing trend among state legislatures to shift the Louisiana 7.7 +22%
emphasis from incarceration to treatment.* Mississippi 6.2 +17%

In October 2017, the HHS deemed the opioid crisis a Missouri 15.9 +36%
national health emergency. This step allows the depart- North Carolina 15.4 +29%
ment to appoint temporary special personnel and to work
Oklahoma 11.6 +4%
with the Drug Enforcement Agency to expand access to
telemedicine to combat addiction.37 South Carolina 13.1 +15%

Tennessee 18.1 +13%

Table 1 depicts the 2016 per capita opioid overdose rate
for the 15 SLC member states and the percentage change Texas 4.9 +4%
from 2015. Nearly all SLC states experienced an increase Virginia 13.5 +36%
in overdose rates from 2015 to 2016. West Virginia, which
has the highest per capita opioid overdose death rate in West Virginia 43.4 +21%
the nation, is considered by many the epicenter for the United States 13.3 +28%
opioid crisis.38 *These numbers are per 100,000 residents and age-adjusted. Age-
adjustment makes groups with varying ages more like the standard
One unanticipated outcome to emerge is the increased population distribution to increase uniformity and comparability.
availability of organs donated from opioid overdose Source: “Opioid Overdose Death Rates and All Drug Overdose
Death Rates per 100,000 Population (Age-Adjusted),” Kaiser
*
For further reading on Southern states’ strategies toward com- Family Foundation, accessed April 9, 2018, https://www.kff.org/
batting the heroin epidemic, see the March 2016 SLC Regional other/state-indicator/opioid-overdose-death-rates/?currentTimeframe=
Resource, "Heroin Epidemic in SLC Member States: Finding Solu- 0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:
tions," at http://slcatlanta.org/Publications/HSPS/HeroinEpidemic.pdf. %22asc%22%7D.

4 OPIOIDS AND ORGAN DONATIONS: A TALE OF TWO CRISES SLC REGIONAL RESOURCE
Figure 1 depicts the increase in deceased organ donors
from 2013 to 2017, nationally. According to UNOS,
preliminary data indicates that the number of total organ
donors (16,462) and the number of deceased donors
(10,286) both set records in 2017.41
Dr. David Klassen, chief medical officer for UNOS, told
CNN “about 40 percent of the increase [in the past five
years] tracks back to the drug intoxication issue.” The
data that UNOS collects does not indicate which drug
caused the overdose, but data on the increasing number of
opioid overdoses, nationally, strongly suggest that opioids
are playing a large role. “The opioid epidemic is clearly
not something anyone expected. It’s clearly a tragic situ-
ation. But there is a little bit of a silver lining.”42
Experts caution that the opioid epidemic is not the sole
cause of the increase in organ donations. Advances in
medical technology, increased public awareness of the
importance of organ donation, and 2013 guidelines from
the Organ Procurement and Transplantation Network
that reclassified intravenous drug users as being at
increased risk—instead of high risk—of carrying human
immunodeficiency virus (HIV), hepatitis B virus (HBV)
and hepatitis C virus (HCV), also contributed to the
growth in donation rates. Under the 2013 guidelines,
doctors are encouraged to discuss with potential recipients
the risks and benefits of accepting organs from increased
risk donors. The guidelines address potential organ donors
who have contracted HIV, HBV, or HCV so recently that
the disease would be undetected during testing. Compli-
ance with the new guidelines is optional for doctors and
medical professionals.43,44
Opt-In vs. Opt-Out
In the United States, potential organ donors must regis-
ter or opt-in to donate. In comparison, in 25 European
nations, all residents are presumed to be donors and
must register to remove themselves from the donor reg-
istry, referred to as an opt-out or “presumed consent”
policy.45 (At the time of this writing, the English and
Scottish Parliaments are considering legislation to become

Figure 1 National deceased organ donors by year and cause of death

12,000
A
10,000
n
n
u
a
l
D
e
8,000
c
e
a
s
e
d
6,000
O
r
g
a
n
D
o
4,000
n
o
r
s

2,000

0
2013 2014 2015 2016 2017

Donors who died from drug overdoses Donors from other causes of death

Source: “Data,” United Network for Organ Sharing, accessed February 23, 2018, https://unos.org/data/.

SLC REGIONAL RESOURCE OPIOIDS AND ORGAN DONATIONS: A TALE OF TWO CRISES 5
opt-out nations.46) According to a 2012 study conducted
by Stanford University and Cornell University, in nations
with presumed consent policies, as many as 90 percent
of citizens are enrolled as organ donors, while as few as
15 percent of citizens in opt-in nations choose to donate
their organs.47
As depicted in Table 2, eight of the 10 nations with the
highest rates of deceased organ donations are opt-out
nations. Conversely, Table 3 demonstrates that nine of
the 10 nations with the highest rate of living organ dona-
tions are opt-in nations. These figures concur with a 2014
academic study which found that deceased donor rates are
higher in opt-out nations, living donor rates are higher
in opt-in nations, and the presence of opt-out policies
influenced donation rates. The study also determined
that opt-out policies were associated with an increase in
the number of livers and kidneys transplanted. However,
the authors warn that in some nations, including France
and Brazil, the introduction of opt-out policies led to a
decrease in donations, possibly because of mistrust of
medical professionals.48
A bill introduced in the Texas Legislature in 2017 would
have made Texas the nation’s first opt-out state. House
Bill 1938 would have added the following question to

2016 worldwide deceased 2016 worldwide living

Table 2 Table 3
organ donors by nation organ donors by nation
Deceased Living donors
donors per Nation per million 2016 population
Nation 2016 population
million residents
residents
Turkey (Opt-Out) 45.8 79.5 million
Spain (Opt-Out) 43.4 46.6 million
South Korea (Opt-In) 43.8 51.2 million
Croatia (Opt-Out) 38.6 4.2 million
Netherlands (Opt-In)* 33.9 17.0 million
Portugal (Opt-Out) 32.6 10.3 million
Saudi Arabia (Opt-In) 27.3 32.2 million
Belgium (Opt-Out) 31.6 11.3 million
Israel (Opt-In) 27.0 8.5 million
United States
31.0 323.4 million Taiwan (Opt-In) 22.2 23.5 million
(Opt-In)
France (Opt-Out) 28.7 66.9 million Denmark (Opt-In) 18.6 5.7 million
Malta (Opt-In) 25.0 0.4 million United States (Opt-In) 18.6 323.4 million
Czech Republic New Zealand (Opt-In) 18.3 4.7 million
25.0 10.6 million
(Opt-Out)
India (Opt-In) 16.7 1,324.1 million
Austria (Opt-Out) 24.9 8.7 million
*A 2018 law making the Netherlands an opt-out nation will
Finland (Opt-Out) 24.7 5.5 million become effective in 2020
Sources: “Final Numbers 2016,” International Registry in Organ Sources: “Final Number 2016,” International Registry in Organ
Donation and Transplantation, December 2017, http://www.irodat. Donation and Transplantation, December 2017, http://www.irodat.
org/img/database/pdf/IRODaT%20newletter%20Final%202016.pdf. org/img/database/pdf/IRODaT%20newletter%20Final%202016.pdf.
Lee Shepherd, Ronan O’Carroll and Eamonn Ferguson, Lee Shepherd, Ronan O’Carroll and Eamonn Ferguson,
“An international comparison of deceased and living organ “An international comparison of deceased and living organ
donation/transplant rates in opt-in and opt-out systems: a panel donation/transplant rates in opt-in and opt-out systems: a panel
study,” BMC Medicine, March 10, 2014, https://bmcmedicine. study,” BMC Medicine, March 10, 2014, https://bmcmedicine.
biomedcentral.com/articles/10.1186/s12916-014-0131-4. biomedcentral.com/articles/10.1186/s12916-014-0131-4.

6 OPIOIDS AND ORGAN DONATIONS: A TALE OF TWO CRISES SLC REGIONAL RESOURCE
all new driver’s license applications: “Would you like to
refuse to join the organ donor registry?” The bill was
opposed by several organ donation organizations in the
state, including Donate Life Texas, because the organi-
zations feared the language would add confusion to the
registration process. The bill was not passed out of the
Transportation Committee.49
Colorado, Connecticut, Pennsylvania and New York
have considered similar legislation, with numerous organ
donation organizations opposing the legislation fearing
that opt-out policies would create a backlash, as it may
be perceived that a person’s organs become property of
the state upon their death and may result in fewer per-
sons registering to become organ donors. According to
a 2012 national survey conducted by HHS, 51 percent
of respondents reported that they would support opt-out
policies. However, 23 percent reported that they would
remove themseleves from the donor registry if their state
adopted opt-out policies. As of this writing, no states have
adopted opt-out policies for organ donation.50
Legislation and Policies
Uniform Anatomical Gift Act
In 1968, the National Conference of Commissioners on
Uniform State Laws—also known as the Uniform Law
Commission (ULC)—drafted the Uniform Anatomical
Gift Act (UAGA) as model legislation to increase legal
uniformity among states. The 1968 UAGA includes the
requirement of a will or other written document (i.e.
organ donor card or driver’s license) to establish donor
consent; establishment of the minimum age to make an
organ donation (18 years old); codification of the legal
power to donate organs, eyes and tissues; and a “good
faith” clause shielding persons from criminal and civil
liability if they are acting in good faith and in accordance
with the Act. The model legislation further states that
the doctor who determines the time of death may not
be involved in any organ removal procedures, to avoid
the appearance of a conflict of interest. 51,52,53
By 1971, the 1968 UAGA was adopted by all 50 states
and the District of Columbia, with only minor variations
between states—on items such as the minimum age to
become an organ donor. (The state of Alaska set the
SLC REGIONAL RESOURCE
minimum organ donor age at 19 years old.) Despite the
Act’s widespread adoption, only four states were willing to
procure organs from a donor based only on the existence
of an organ donor card, with the remaining states defer-
ring to the wishes of relatives. Additionally, the Act did
little to close the gap between the demand and available
supply of organs for transplant.54
To address these concerns, the ULC drafted an update to
the UAGA in 1987. The updated UAGA, which repealed
the 1968 version, explains that a decedent’s relatives could
not override his or her desire to be an organ donor,
requires medical personnel to ask a patient about his or
her organ donation preference “on or before admission
to a hospital,” and to ask the patient’s relatives of the
patient’s organ donation preference “at or near the time
of death of a patient.”55,56 Additionally, Section 4 permits
medical examiners to authorize organ donation without
the consent of the patient’s next of kin, provided that the
examiner made a “reasonable effort” to contact the next
of kin. With many states apprehensive about the idea of
requiring medical personnel to make inquiries at such
sensitive times and medical examiners authorizing organ
donation without the consent of the donor’s next of kin,
only 26 states adopted the 1987 UAGA.57
With half of the nation adhering to the 1968 UAGA
and half following the 1987 revision, the ULC drafted
a third version of the UAGA in 2006 to eliminate legal
differences by creating new standards. The 2006 UAGA,
also known as the Revised Uniform Anatomical Gift Act,
contains updates including legal recognition of an indi-
vidual’s organ donor status as declared on their driver’s
license or government-issued ID card, elimination of
donor status overrides by the donor’s relatives, creation
of standards for organ donor registries, and repeal of the
state’s prior version of the UAGA.58 Currently, the 2006
UAGA has been adopted by 46 states and the District
of Columbia.59
National Organ Transplant Act
In 1984, with survival rates for organ transplants and
demand for organs increasing, the U.S. Congress passed
the National Organ Transplant Act (NOTA), which
banned the sale of organs, established the Task Force
OPIOIDS AND ORGAN DONATIONS: A TALE OF TWO CRISES 7
on Organ Transplantation and permitted HHS to pro-
vide grants to organ procurement organizations. The
legislation also called for the creation of the Scientific
Registry of Transplant Recipients and formed a unit
within HHS to manage these functions. Finally, NOTA
created the Organ Procurement and Transplantation
Network (OPTN), a national network to promote organ
transplants, operated by a private organization and man-
aged by HHS.60 All transplant hospital programs, organ
procurement organizations and transplant compatibility
laboratories in the nation are members of OPTN.61
Since 1986, UNOS has worked with HHS to provide
this national network.62 Since securing the first federal
contract, UNOS has created a national organ sharing
system to increase the efficient use of donated organs;
developed a system to collect and analyze an organ trans-
plant waiting list and donor data; and assisted persons
and organizations interested in organ transplantation
with the process.63
SLC Member States
The 2006 version of the UAGA has been passed in 14
states in the SLC region. Florida passed the original ver-
sion of the UAGA in 1968 and has passed many revisions
to the law in subsequent years, but has not passed the
2006 revision. All 15 states in the SLC region have passed
legislation to encourage the practice of organ donation,
allowing residents to register to become organ donors
through the state DMV (or similar entity) or through a
state organ donation registry.64
A discussion of all statewide legislation and policies
regarding organ donation is beyond the scope of this SLC
Regional Resource. However, to highlight the importance
that SLC member states place on organ donation, the
following section highlights statewide organ donation
legislation related to funding and tax incentives; state
and private sector employee leave laws; and education/
awareness initiatives. Table 4 provides organ donation
statistics for the 15 SLC member states. In this table
and all subsequent references, “actual donors” refers to
individuals who donated organs, not individuals who
registered to be organ donors. Data on the number of
individuals registered as organ donors was unavailable.
8 OPIOIDS AND ORGAN DONATIONS: A TALE OF TWO CRISES
Table 5 provides an overview of state organ donation
laws in SLC member states.
Alabama
The Legislature adopted the 2006 version of the UAGA
in 2008.65 Additionally, Section 22-19-71.1 of the Code of
Alabama requires the Alabama Law Enforcement Agency
(ALEA) to create and implement a program promoting
organ donation and provide information on organ dona-
tion at all driver’s license offices.66 The ALEA allows
individuals to renew their driver’s license and register to
be an organ donor online. Each year, in recognition of
National Donor Day on February 14, the state encour-
ages all individuals renewing their license to register to
become an organ donor.67
Arkansas
In addition to passing the 2006 version of the UAGA in
2007, the General Assembly has passed several laws related
to organ donation. A law passed in 2005 permits taxpay-
ers to deduct up to $10,000 of unreimbursed expenses
incurred due to a living organ donation.68 Expenses may
include travel, lodging, lost wages and medical costs.
Additionally, Arkansas grants state and public school
employees up to 30 days of paid leave for living organ
donations and up to seven days of paid leave for bone
marrow donation. The state requires private sector
employers to provide their employees up to 90 days of
unpaid leave for living organ donations. If a private sector
employer provides paid leave for living organ donation,
the state grants a 25 percent tax credit* to the employer
for the wages paid.69
In 2003, the General Assembly created the Organ Donor
Awareness Education Trust Fund, which is adminis-
tered by the state treasurer, state auditor and the state
chief fiscal officer. The fund, which accepts grants and
donations, is designed to promote organ donation using
educational and informational materials.70 Another law
passed in 2003 states that driver education courses and
*
A tax credit lowers a taxpayer's tax liability by a specified amount.
A tax credit cannot lower a taxpayer's liability to less than zero.
Tax credits differ from tax deductions, which lower a taxpayer's
taxable income.
SLC REGIONAL RESOURCE
 Care Administration (AHCA)
to two-year terms. Furthermore,
Table 4 2017 Organ Donation Statistics the state law specifies guidelines
for the AHCA to certify organ
Total Actual
Actual Actual Total procurement organizations. The
State Donors Per
State Living Deceased Actual Revised Uniform Anatomical
Population Million State
Donors Donors Donors Gift Act does not contain these
Residents
three aspects or equivalents.72
Alabama 87 172 259 4.8 million 53.9

Arkansas 22 74 96 3 million 32 Additionally, Section 765.5155

Florida 264 680 944 20.9 million 45.2 of the Florida Statutes calls for
the AHCA to identify a private
Georgia 173 288 461 10.4 million 44.3 contractor to maintain the state’s
Kentucky 71 117 188 4.4 million 42.7 donor registry and education
program. This contractor also
Louisiana 84 183 267 4.7 million 56.8
must provide an annual report
Mississippi 29 110 139 2.9 million 47.9 to the AHCA detailing the num-
ber of donors on the registry
Missouri 95 283 378 6.1 million 61.9
and amount of financial contri-
North butions; analyzing registration
135 308 443 10.2 million 43.4
Carolina
rates and donor characteristics;
Oklahoma 50 189 239 3.9 million 61.2 and reviewing educational cam-
South paigns and activities completed
55 176 231 5 million 46.2
Carolina each year.73 Donate Life Flor-
Tennessee 99 281 380 6.7 million 56.7 ida, the state affiliate of Donate
Life America, is the designated
Texas 482 897 1,379 28.3 million 48.7
contractor.
Virginia 208 212 420 8.5 million 49.4
Georgia
West Virginia 26 54 80 1.8 million 44.4
In 2008, Georgia passed the
Source: “State Data,” Organ Procurement and Transplantation Network, U.S. Department of
Revised UAGA. Like Arkansas,
Health and Human Services.
the state permits taxpayers to
high school health courses must include information on deduct up to $10,000 of expenses incurred due to mak-
organ and tissue donation.71 ing a living organ donation.74 Also like Arkansas, Section
45-20-31 of the Official Code of Georgia grants state
Florida employees up to 30 days of paid leave for living organ
Florida’s organ donation laws combine aspects of both donations and up to seven days of paid leave for bone
the 1968 and 2006 UAGA with several variations. marrow donation.75
Florida’s law creates a ranked list of relatives and associ-
ates who may choose to make an anatomical gift if the Kentucky
decedent has not made his or her wishes known and In addition to following the 2006 UAGA, Kentucky
has not designated a “health surrogate” to make such recognizes the fourth week of April each year as Organ
decisions. Florida’s legislation also establishes an Organ Donor Awareness Week, in conjunction with the decla-
Transplant Advisory Council, comprised of 12 physicians ration of April as National Donate Life Month. During
appointed by the secretary of the Agency for Health this week, the governor and the Legislature honor organ

SLC REGIONAL RESOURCE OPIOIDS AND ORGAN DONATIONS: A TALE OF TWO CRISES 9
 Table 5 State organ donation laws in SLC states
Private sector Organ donation
State incentives and
Version of the State employee leave laws employee leave education/
State requirements to
UAGA codified for organ donation laws for organ awareness
increase organ donation
donation initiatives

Information at all
Alabama 2006 DMV offices,
§ 22-19-71.1

Up to $10,000 Organ Organ Donor

Donation Tax Deduction, Awareness Education
Up to 30 days of paid leave
§ 26-51-2103. Up to 90 days of Trust Fund,
for organ donation. Up to 7
Arkansas 2006 25 percent tax credit for unpaid leave, § 20-17-502.
days of paid leave for bone
employers who provide § 11-3-205. Information in high
marrow donation § 21-4-215.
paid leave, school courses,
§ 21-4-215. § 6-16-501.

Donor registry and

Florida 1968* education program,
§ 765.5155.
Up to 30 days of paid leave
Up to $10,000 Organ for organ donation. Up to
Georgia 2006 Donation Tax Deduction, 7 days of paid leave for
§ 48-7-27. bone marrow donation, §
45-20-31.
Require medical
examiners to contact Organ Donor
Kentucky 2006 organ procurement Awareness Week,
organization, House Bill § 2.240.
84 (2018).
Up to $7,200 Organ
Donation Tax Credit, Up to 40 hours
Louisiana Organ
§ 47:297:N. Up to 40 hours of paid leave of paid leave for
Procurement Agency
Louisiana 2006 18 percent tax credit to for bone marrow donation, bone marrow
partners with driver
employers who provide § 40:1263.4. donation,
education programs.
paid leave, § 40:1263.4.
§ 47:287.758.

Up to $10,000 Organ Up to 30 days of paid leave Information in driver

Mississippi 2006 Donation Tax Deduction, for organ and bone marrow education courses,
§ 27-7-18. donation, § 25-3-103. § 37-25-5.

Information at all
Up to 30 days of paid leave DMVs and secondary
for organ donation. Up to 5 schools § 194.299.
Missouri 2006
days of paid leave for bone Organ Donor Trust
marrow donation. §105.266 Fund,
§ 143.1016.

10 OPIOIDS AND ORGAN DONATIONS: A TALE OF TWO CRISES SLC REGIONAL RESOURCE
 Table 5 State organ donation laws in SLC states
(continued)
Private sector Organ donation
State incentives and
Version of the State employee leave laws employee leave education/
State requirements to
UAGA codified for organ donation laws for organ awareness
increase organ donation
donation initiatives
Information at all
DMV offices,
License to Give Trust
North § 20-7.3.
2006 Fund established,
Carolina Organ Donation
§ 20-7.4.
Awareness/Donate
Life Month, § 103-12.
Up to 30 days of paid leave Oklahoma Organ
Up to $10,000 Organ for organ donation, Up to Donor Education and
Oklahoma 2006 Donation Tax Deduction, 5 days of paid leave for Awareness Program
§68-2358(E). bone marrow donation, Revolving Fund,
§74-840-2.20(B). §63-2220.3.

Up to 30 days of paid leave

Up to 40 hours of
for organ donation, §8-11-65. Donate Life South
South paid leave for bone
2006 Up to 40 hours of paid leave Carolina,
Carolina marrow donation,
for bone marrow donation, § 44-43-1310.
§44-43-80.
§44-43-80.

Schools are
encouraged to
Tennessee 2006 promote awareness
of organ donation,
§ 49-6-1012.
Up to 30 days of paid leave Glenda Dawson
for organ donation, Up to 5 Donate Life-Texas
Texas 2006 days of paid leave for bone Registry, Texas
marrow donation Texas Health and Safety
Government Code, §661.916. Code § 692A.020.
Up to $5,000 Organ
Up to 30 days of paid leave Information in driver
and Tissue Donation Tax
Virginia 2006 for organ and bone marrow education courses,
Deduction,
donation, § 2.2-2821.1. § 22.1-205.
§ 58.1-322.03.
Up to 120 hours of paid leave
for kidney and liver donation,
West Virginia 2006 Up to 56 hours of paid leave
for bone marrow donation,
§29-6-27 and §29-6-28.
*Florida adopted the 1968 UAGA and has passed siginificat revisions in subsequent years.
Sources: “Donor Leave Laws and Tax Deduction/Credits for Living Donors,” National Kidney Foundation, https://www.kidney.org/sites/
default/files/LDTaxDed_Leave.pdf.
“State Organ Donation Legislation,” U.S. Health Resources and Services Administration, https://www.organdonor.gov/legislation_micro/.
“Donor Leave Statutes by State,” National Marrow Donor Program, June 1, 2017, https://bethematch.org/uploadedfiles/bethematchcontent/
support_the_cause/donate_bone_marrow/donor_safety_and_support/donor_leave/donorleavestatutesstate0617(1)(1).pdf.

SLC REGIONAL RESOURCE OPIOIDS AND ORGAN DONATIONS: A TALE OF TWO CRISES 11
donors and the surviving family members of organ donors
with a ceremony in the Capitol rotunda. All organ donors
are recognized collectively by citation, with copies of the
citation available upon request to the donor or donor’s
family.76
House Bill 84 (2018), which unanimously passed both
chambers of the Legislature, requires coroners and medical
examiners to contact the Kentucky Organ Donor Affili-
ates (KODA), the commonwealth’s organ procurement
organization, if a decedent’s body is medically viable for
organ or tissue donation. Prior to the bill’s passage, only
hospitals were required to notify KODA when a decent
who had registered as an organ donor passed away. The
bill also is known as “Courtney’s Law,” in honor of the
late Courtney Flear, who had signed her driver’s license
indicating her intention to be an organ donor, but was not
referred to KODA after she died from injuries sustained
in an automobile accident.77,78
Louisiana
In 2010, the Legislature passed the 2006 UAGA. Addi-
tionally, the state grants a tax credit up to $7,200 on
individual tax returns for expenses incurred due to mak-
ing a living organ donation.79 The state also requires
all employers, public and private, to provide up to 40
hours of paid leave for bone marrow donation.80 When an
employer provides paid leave for a living organ donation,
the state provides an 18 percent tax credit to the employer
for the wages paid. This tax credit also will cover the
costs that an employer may incur for the development
of an employee bone marrow donation education pro-
gram, payments to a healthcare provider for determining
a donor’s tissue type, and employee transportation to a
medical facility for a bone marrow donation procedure.81
The Louisiana Organ Procurement Agency administers
the state’s organ donor registry and recovers organs for
transplants. The agency also works in partnership with
Donate Life Louisiana, the state’s Donate Life affiliate,
to promote the importance of organ donation through
outreach and education, including providing materials
to driver’s education courses in the state.82
12 OPIOIDS AND ORGAN DONATIONS: A TALE OF TWO CRISES
Mississippi
Mississippi adopted the Revised UAGA in 2008. Also,
like Arkansas and Georgia, Mississippi allows a tax deduc-
tion up to $10,000 for any expenses incurred resulting
from making a living organ donation.83 State employees
are granted up to 30 days of paid leave for living organ
or bone marrow donation, one of the most generous
organ donation leave laws in the South.84 Driver educa-
tion courses in public schools are required to include
instruction on the process of organ and tissue donation.85
Missouri
The General Assembly passed the 2006 UAGA two years
after its creation. Missouri also grants state employees up
to 30 days of paid leave for making a living organ dona-
tion and up to five days of paid leave for bone marrow
donation.86 Section 194.299 of the Missouri Revised Stat-
utes requires information on organ donation to be shared
with residents obtaining or renewing a driver’s license and
requires secondary schools to implement organ donation
awareness programs, funded through donations to the
state’s organ donor program fund. 87 Section 143.1016
of the Missouri Revised Statutes establishes the Missouri
Organ Donor Trust Fund to receive donations.88
North Carolina
In 2008, the General Assembly adopted the Revised
UAGA. Additionally, Section 20-7.4 of the North
Carolina General Statutes establishes the License to Give
Trust Fund to receive donations from individuals and
organizations and allocate those funds for initiatives that
promote and educate about organ and tissue donation.89
Section 20-7.5 establishes the License to Give Trust Fund
Commission to administer the fund. The commission’s
members are appointed by executive and legislative branch
leadership, with the governor appointing seven members,
president pro tempore of the Senate four members, and
the speaker of the House of Representatives four.90 Fur-
thermore, the Division of Motor Vehicles is required to
make donor cards that declare an individual’s donor status
available at motor vehicle offices to all organ donors. 91
Additionally, the state recognizes April as Organ Dona-
tion Awareness/Donate Life Month in accordance with
SLC REGIONAL RESOURCE
National Donate Life Month, as instituted by Donate
Life America.92
Oklahoma
Three years after its creation, the Legislature approved
the 2006 UAGA. Like Arkansas, Georgia and Missis-
sippi, Oklahoma allows a tax deduction up to $10,000
for any expenses incurred from making a living organ
donation.93 Furthermore, like neighboring Missouri,
Oklahoma grants state employees up to 30 days of paid
leave for making a living organ donation and up to five
days of paid leave for bone marrow donation.94 Like other
states with similar programs, the state’s Oklahoma Organ
Donor Education and Awareness Program Revolving
Fund was established to raise awareness of the importance
and value of organ donation. The fund helps to pay for
informational materials, educational programs in public
schools and grants to organ procurement organizations
in the state.95
South Carolina
Like Oklahoma, South Carolina adopted the 2006 UAGA
three years after the model legislation was drafted. Simi-
lar to Missouri and Oklahoma, South Carolina allows
state employees to take up to 30 days of paid leave for
a living organ donation96 and up to 40 hours of paid
leave for bone marrow donation.97 Additionally, the state
requires private sector employers to provide employees up
to 40 hours of paid leave for bone marrow donation.98
Section 44-43-1310 of the South Carolina Code of Laws
establishes Donate Life South Carolina as a nonprofit
organization to promote and encourage organ and tissue
donation in the state.99 The organization is administered
by a board of directors, whose 10 members are appointed
by the governor.100
Tennessee
In 2007, the General Assembly codified the 2006 UAGA.
Under Section 49-6-1012 of the Tennessee Code, school
districts are encouraged to promote organ and tissue
donation.101 In July 2017, the Tennessee Department of
Safety and Homeland Security partnered with Donate
Life Tennessee to promote the importance of organ dona-
tion. As part of the “Bells for Life” pilot program, each
time someone registers as an organ donor at a state Drivers
SLC REGIONAL RESOURCE
Service Center, a staff member invites the newly regis-
tered donor to ring a bell and receive a round of applause
from staff. For the first phase of the pilot program, six
of the state’s 86 Drivers Service Centers are participat-
ing. At the start of the program, 34 percent of licensed
drivers in the state were registered as organ donors; the
goal is to register 50 percent of licensed drivers as organ
donors.102,103
Texas
Like Oklahoma and South Carolina, the Texas Legislature
adopted the 2006 UAGA in 2009. Also, like Missouri,
Oklahoma and South Carolina, Texas offers state employ-
ees up to 30 days of paid leave for making a living organ
donation and up to five days of paid leave for bone mar-
row donation.104
In 2005, the Legislature called for Donate Life Texas, the
statewide affiliate of the national Donate Life America
organization, to maintain and administer a statewide
organ donor registry entitled the Glenda Dawson Donate
Life-Texas Registry. The legislation also established the
Glenda Dawson Donate Life-Texas Registry Fund to
receive donations from individuals and organizations
and use those funds to design and distribute organ dona-
tion educational materials to prospective donors.105 The
registry and fund are named in honor of the late Repre-
sentative Glenda Dawson, a kidney transplant recipient
and organ donation advocate.106
Virginia
One year after its creation, the Virginia General Assem-
bly adopted the 2006 UAGA. Furthermore, Section
58.1-322.03 of the Code of Virginia allows taxpayers to
deduct up to $5,000 of unreimbursed expenses incurred
due to a living organ donation.107 Like Mississippi, Vir-
ginia state employees are permitted up to 30 days of
paid leave for organ or bone marrow donation.108 Section
22.1-205 of the Code instructs the Board of Education
to establish a standardized driver education program that
includes organ and tissue donor awareness.109
West Virginia
West Virginia passed the Revised UAGA in 2008. Addi-
tionally, Section 29-6-28 of the West Virginia Code
OPIOIDS AND ORGAN DONATIONS: A TALE OF TWO CRISES 13
grants state employees up to 120 hours of paid leave for
a living donation of a liver lobe or kidney and up to 56
hours of paid leave for bone marrow donation.110
Conclusion
The opioid crisis cannot be overlooked as a significant
variable in the discussion of organ donor laws. State poli-
cymakers have an opportunity to consider a number of
practical and long-term policy options that could increase
the number of organ donations as well as expand the
existing mechanisms available to become an organ donor.
Recognizing the relatively small number of organ trans-
plants that occur annually in the United States relative to
the population—whether via living or deceased donations—
couple with the alarmingly high death rate associated
with the opioid crisis, state policymakers are at a juncture
where a closer examination of current laws addressing
organ donation may be warranted.
With an average of 20 Americans dying each day while
waiting for an organ transplant,111 there is a clear need
for states to find innovative and effective measures to
reduce this number. While this number may never be
zero, there are several practical and immediate measures
that states may consider adopting to optimize the current
organ donation process. Policies designed to promote
living organ donation may be part of the solution. The
adoption of an opt-out organ donation system also may
warrant consideration. This approach has been successful
in Europe, but may face hurdles in the United States,
as the perception is that upon death a person’s organs
become property of the state. Some have argued that
overturning the section of the National Organ Trans-
plant Act that prohibits the sale of organs would lead to
more organ donations.112 However, there are concerns
Further Resources
The following websites provide useful information for individuals who want to learn more:
»» United Network for Organ Sharing, https://unos.org/
»» Donate Life America, https://www.donatelife.net/
»» National Institute on Drug Abuse, https://www.drugabuse.gov/
14 OPIOIDS AND ORGAN DONATIONS: A TALE OF TWO CRISES
that this might result in a system that would permit, or
perhaps encourage, individuals to sell their organs for
financial gain.
State legislators may wish to consider the following
recommendations:
»» Creating state task forces to review moving from an
opt-in policy to an opt-out policy for organ donation
»» For those states seeking to implement an opt-out policy,
crafting language that is unambiguous
»» Increasing opportunities and frequency at state agency
points-of-contact for citizens to affirm their wish to
be an organ donor
»» Lowering fees to renew/obtain a driver’s license when
enrolling as an organ donor
»» Requiring education on organ donation in driver edu-
cation (or other) public school courses
»» Producing more public service announcements on the
importance of organ donation
»» Requiring employers to provide paid or unpaid leave
to employees who make living organ donations
»» Providing tax deductions/credits to individuals who
make living organ donations
»» Encouraging medical personnel to inform drug over-
dose survivors about the value of organ donation
With no immediate solution to the opioid crisis, the
linkage between the unprecedented number of opioid
related premature deaths and ameliorating the shortage
of organ donations may present policy options that pre-
viously did not exist. Policymakers may consider these
recommendations or may develop new policies with input
from organ procurement agencies, medical personnel and
addiction experts. Ultimately, a multifaceted approach
may prove the most beneficial.
SLC REGIONAL RESOURCE
Endnotes

1. Nadia Kounang, “Opioids now kill more people than breast cancer,” CNN, December 21, 2017,
https://www.cnn.com/2017/12/21/health/drug-overdoses-2016-final-numbers/index.html.
2. Lenny Bernstein and Christopher Ingraham, “Fueled by drug crisis, U.S. life expectancy declines for a second
straight year,” The Washington Post, December 21, 2017, https://www.washingtonpost.com/national/health-science/
fueled-by-drug-crisis-us-life-expectancy-declines-for-a-second-straight-year/2017/12/20/2e3f8dea-e596-11e7-ab50-
621fe0588340_story.html?noredirect=on&utm_term=.29770e901ad9.
3. “Organ Procurement and Transplantation Network,” Organ Procurement and Transplantation Network, U.S.
Department of Health and Human Services, accessed March 21, 2018, https://optn.transplant.hrsa.gov/.
4. “Organ Donation Statistics,” U.S. Department of Health and Human Services, accessed February 23, 2018,
https://www.organdonor.gov/statistics-stories/statistics.html.
5. “Organ Procurement and Transplantation Network,” Organ Procurement and Transplantation Network.
6. “Data,” United Network for Organ Sharing, accessed February 23, 2018, https://unos.org/data/.
7. “Organ Donation Statistics,” U.S. Department of Health and Human Services.
8. “History,” Organ Procurement and Transplantation Network, U.S. Department of Health and Human Services,
accessed February 1, 2018, https://optn.transplant.hrsa.gov/learn/about-transplantation/history/.
9. “Organ Transplants: A Brief History,” History.com, February 21, 2012,
http://www.history.com/news/organ-transplants-a-brief-history.
10. “History,” Organ Procurement and Transplantation Network.
11. “Transplantation: Organ Transplant History,” Live On NY, accessed February 1, 2018,
http://www.liveonny.org/all-about-transplantation/organ-transplant-history/.
12. “Register,” U.S. Department of Health and Human Services, accessed February 22, 2018,
https://organdonor.gov/register.html.
13. “Matching Donors and Recipients,” U.S. Department of Health and Human Services, accessed March 1, 2018,
https://www.organdonor.gov/about/process/matching.html.
14. “The Living Donation Process,” U.S. Department of Health and Human Services, accessed March 1, 2018,
https://www.organdonor.gov/about/process/living-donation.html.
15. “Donation Process,” Center for Organ Recovery and Education, accessed on April 6, 2018,
https://www.core.org/understanding-donation/donation-process/.
16. Leah Samuel, “To solve organ shortage, states consider ‘opt-out’ organ donation laws,” STAT News, July 6, 2017,
https://www.statnews.com/2017/07/06/opt-solution-organ-shortage/.
17. “Organ Donation Statistics,” U.S. Department of Health and Human Services.
18. “Find your Local Organ Procurement Organization,” U.S. Department of Health and Human Services, accessed on
February 22, 2018, https://www.organdonor.gov/awareness/organizations/local-opo.html.
19. “The Basic Path of Donation,” Organ Procurement and Transplantation Network,
U.S. Department of Health and Human Services, accessed on February 22, 2018,
https://optn.transplant.hrsa.gov/learn/about-donation/the-basic-path-of-donation/.
20. Ibid.
21. “Organ Donation FAQs,” U.S. Department of Health and Human Services, accessed on February 27, 2018,
https://www.organdonor.gov/about/facts-terms/donation-faqs.html.

SLC REGIONAL RESOURCE OPIOIDS AND ORGAN DONATIONS: A TALE OF TWO CRISES 15
22. “The Living Donation Process,” U.S. Department of Health and Human Services.
23. “FAQs,” National Living Donor Assistance Center, accessed March 9, 2018,
https://www.livingdonorassistance.org/public/faq.aspx.
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Services, accessed on February 22, 2018, https://optn.transplant.hrsa.gov/learn/about-transplantation/transplant-process/.
25. “How Organ Allocation Works,” Organ Procurement and Transplantation Network,
U.S. Department of Health and Human Services, accessed on February 22, 2018,
https://optn.transplant.hrsa.gov/learn/about-transplantation/how-organ-allocation-works/.
26. “Donation Process,” Center for Organ Recovery and Education.
27. Jacque Wilson, “New transplant technology keeps organs ‘alive’ outside body,” CNN, April 25, 2013,
https://www.cnn.com/2013/04/25/health/live-organ-transplants/index.html.
28. Rob Stein, “Searching For A Fairer Way To Distribute Donor Livers,” NPR, September 26, 2017,
https://www.npr.org/sections/health-shots/2017/09/26/549224583/searching-for-a-fairer-way-to-distribute-donor-livers.
29. “Enhancing liver distribution,” Organ Procurement and Transplantation Network,
U.S. Department of Health and Human Services, accessed on April 28, 2018,
https://optn.transplant.hrsa.gov/governance/public-comment/enhancing-liver-distribution/.
30. “Opioids,” National Institute on Drug Abuse, accessed April 10, 2018, https://www.drugabuse.gov/drugs-abuse/opioids.
31. Nadia Kounang, “Opioids now kill more people than breast cancer.”
32. Rose Rudd, MSPH, Puja Seth, Ph.D., Felicita David, MS, and Lawrence Scholl, Ph.D., “Increases in Drug and
Opioid-Involved Overdose Deaths – United States 2010-2015,” Centers for Disease Control and Prevention,
December 30, 2016, https://www.cdc.gov/mmwr/volumes/65/wr/mm655051e1.htm?utm_campaign=colorado.
ourcommunitynow.com%20website&utm_source=ocn_story&utm_medium=website#suggestedcitation.
33. Allison Bond, “Why fentanyl is deadlier than heroin, in a single photo,” STAT News, September 29, 2016,
https://www.statnews.com/2016/09/29/why-fentanyl-is-deadlier-than-heroin/.
34. Jacqueline Howard, “How a 22-year-old’s overdose death saved lives,” CNN, October 11, 2016,
https://www.cnn.com/2016/10/11/health/drug-overdose-deaths-organ-donation/index.html.
35. Nadia Kounang, “Drug overdoses contribute to record number of organ donors.”
36. Rob Stein, “Jump in overdoses shows opioid epidemic has worsened,” NPR, March 6, 2018,
https://www.npr.org/sections/health-shots/2018/03/06/590923149/jump-in-overdoses-shows-opioid-epidemic-has-worsened.
37. “HHS Acting Secretary Declares Public Health Emergency to Address National Opioid Crisis,” U.S. Department
of Health and Human Services, October 26, 2017, https://www.hhs.gov/about/news/2017/10/26/hhs-acting-secretary-
declares-public-health-emergency-address-national-opioid-crisis.html.
38. “Opioid Overdose Death Rates and All Drug Overdose Death Rates per 100,000 Population (Age-Adjusted),” Kaiser
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Timeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D.
39. Nadia Kounang, “Drug overdoses contribute to record number of organ donors.”
40. Bighui Huang, “Through opioid epidemic, more organs available for transplant patients,” The Morning Call, August
4, 2017, http://www.mcall.com/health/mc-nws-biz-health-organdonor-opioid-20170727-story.html.
41. “National Data: Transplants by Donor Type,” Organ Procurement and Transplantation Network,
U.S. Department of Health and Human Services, accessed March 1, 2018,
https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/.

16 OPIOIDS AND ORGAN DONATIONS: A TALE OF TWO CRISES SLC REGIONAL RESOURCE
42. Ibid.
43. Ibid.
44. Christopher L. Wholley, “Guidance on Explaining Risk Related to Use of U.S. PHS Increased
Risk Donor Organs When Considering Organ Offers,” OPTN/UNOS, June 2017,
https://optn.transplant.hrsa.gov/media/2171/dtac_boardreport_201706.pdf.
45. Leah Samuel, “To solve organ shortage, states consider ‘opt-out’ organ donation laws,” STAT, July 6, 2017,
https://www.statnews.com/2017/07/06/opt-solution-organ-shortage/.
46. Richard Pérez-Peña, “U.K. Moves Toward Making Adults Presumed Organ Donors,” The New York Times,
February 23, 2018, https://www.nytimes.com/2018/02/23/world/europe/uk-organ-donation.html.
47. Leah Samuel, “To solve organ shortage, states consider ‘opt-out’ organ donation laws.”
48. Lee Shepherd, Ronan O’Carroll and Eamonn Ferguson, “An international comparison of deceased and living organ
donation/transplant rates in opt-in and opt-out systems: a panel study,” BMC Medicine, March 10, 2014,
https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-014-0131-4.
49. Alyssa Goard, “Texas bill aims to make organ donation opt-out, sparking debate,” KXAN News, April 27, 2017,
http://kxan.com/2017/04/27/texas-bill-aims-to-make-organ-donation-opt-out-sparking-debate/.
50. Nicole Cobler, “Bill would require Texans to opt out of organ donation,” Houston Chronicle, February 28, 2017, https://
www.chron.com/local/texas-politics/texas-legislature/article/Bill-would-require-Texans-to-opt-out-of-organ-10963486.php.
51. “Transplantation: Organ Transplant History,” Live On NY.
52. “Anatomical Gift Act (2006) Summary,” National Conference of Commissioners on Uniform State Laws, accessed
February 16, 2018, http://www.uniformlaws.org/ActSummary.aspx?title=Anatomical%20Gift%20Act%20(2006).
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https://www.ahcmedia.com/articles/37387-the-gift-of-life-understanding-anatomical-gift-law.
54. Ibid.
55. Ibid.
56. “Uniform Anatomical Gift Act (1987),” National Conference of Commissioners on Uniform State Laws, 1987,
http://www.uniformlaws.org/shared/docs/anatomical_gift/uaga87.pdf.
57. David L. Freedman, M.D., “The Gift of Life: Understanding Anatomical Gift Law.”
58. “Anatomical Gift Act (2006) Summary,” National Conference of Commissioners on Uniform State Laws.
59. “Legislative Fact Sheet – Anatomical Gift Act (2006),” National Conference of
Commissioners on Uniform State Laws, accessed February 21, 2018,
http://www.uniformlaws.org/LegislativeFactSheet.aspx?title=Anatomical%20Gift%20Act%20(2006).
60. “Selected Statutory and Regulatory History of Organ Transplantation,” U.S. Department of Health and Human
Services, accessed on February 22, 2018, https://organdonor.gov/about-dot/laws/history.html.
61. “Members,” Organ Procurement and Transplantation Network, U.S. Department of Health and Human Services,
accessed on February 20, 2018, https://optn.transplant.hrsa.gov/members/.
62. “National Organ Transplant Act enacted 30 years ago,” United Network for Organ Sharing, October 19, 2014,
https://unos.org/national-organ-transplant-act-enacted-30-years-ago/.
63. “History,” United Network for Organ Sharing, accessed February 22, 2018, https://unos.org/transplantation/history/.
64. “State Organ Donation Legislation,” U.S. Health Resources and Services Administration, Accessed February 1, 2018,
https://www.organdonor.gov/legislation_micro/.

SLC REGIONAL RESOURCE OPIOIDS AND ORGAN DONATIONS: A TALE OF TWO CRISES 17
65. Code of Alabama, § 22-19-170.
66. Code of Alabama, § 22-19-71.1.
67. “Renew Your Alabama Driver’s License and Become an Organ Donor,” The New York
Times, February 2, 2018, http://markets.on.nytimes.com/research/stocks/news/press_release.
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68. Arkansas Code, § 26-51-2103.
69. Arkansas Code, § 21-4-215.
70. Arkansas Code, § 20-17-502.
71. Arkansas Code, § 6-16-501.
72. James Doty and Sean Conley, “Comparison of UAGA (2006) with existing Florida Law,”
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73. Florida Statutes, Section 765.5155.
74. Official Code of Georgia, § 48-7-27.
75. Official Code of Georgia, § 45-20-31.
76. Kentucky Revised Statutes, § 2.240.
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80. Louisiana Revised Statutes, 40:1263.4.
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83. Mississippi Code, § 27-7-18.
84. Mississippi Code, § 25-3-103.
85. Mississippi Code, §  37-25-5.
86. Missouri Revised Statutes, § 105.266.
87. Missouri Revised Statutes, § 194.299.
88. Missouri Revised Statutes, § 143.1016.
89. North Carolina General Statutes, § 20-7.4.
90. North Carolina General Statutes, § 20-7.5.
91. North Carolina General Statutes, § 20-7.3.
92. North Carolina General Statutes, § 103-12.
93. Oklahoma Statutes, §68-2358(E).
94. Oklahoma Statutes, §74-840-2.20(B).
95. Oklahoma Statutes, §63-2220.3.
96. South Carolina Code of Laws, §8-11-65.

18 OPIOIDS AND ORGAN DONATIONS: A TALE OF TWO CRISES SLC REGIONAL RESOURCE
97. South Carolina Code of Laws, §44-43-80.
98. South Carolina Code of Laws, §44-43-80.
99. South Carolina Code of Laws, §44-43-1310.
100. South Carolina Code of Laws, §44-43-1320.
101. Tennessee Code, § 49-6-1012.
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103. Kristi Nelson, “Could bells ‘ring in’ a new era for organ donation? Tennessee works to get more donors
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109. Code of Virginia, § 22.1-205.
110. West Virginia Code, §29-6-28.
111. “Data,” United Network for Organ Sharing.
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SLC REGIONAL RESOURCE OPIOIDS AND ORGAN DONATIONS: A TALE OF TWO CRISES 19
REGIONAL VIEW NATIONAL REACH
T
his report was prepared by Nick Bowman, research
and publications associate for the Southern Legislative
Conference of The Council of State Governments. This
report reflects the policy research made available to appointed
and elected state officials by the Southern Office of The Council
of State Governments (CSG).
Opened in 1959, the Southern Office of CSG promotes
intergovernmental cooperation among its 15 member states,
predominantly through the programs and services provided by
its Southern Legislative Conference (SLC). Legislative leader-
ship, members and staff utilize the SLC to identify and analyze
government policy solutions for the most prevalent and unique
issues facing Southern states. Meanwhile, SLC member outreach
in state capitols and coordination of domestic and international
delegations, leadership development and staff exchange pro-
grams, meetings, and fly-ins programs, meetings, and fly-ins
Southern Legislative Conference and SLC are trademarks registered in the U.S. Patent and Trademark Office.
support state policymakers and legislative staff in their work
to build a stronger region.
Established in 1947, the SLC is a member-driven organization
and the largest of four regional conferences of CSG, comprising
the states of Alabama, Arkansas, Florida, Georgia, Kentucky,
Louisiana, Mississippi, Missouri, North Carolina, Oklahoma,
South Carolina, Tennessee, Texas, Virginia and West Virginia.
The Annual Meeting of the Southern Legislative Conference,
convened as the focal point and apex of its activities, is the
premier public policy forum for Southern state legislatures
and the largest regional gathering of legislative members and
staff. The Annual Meeting and a broad array of similarly well-
established and successful SLC programs — focusing on both
existing and emerging state government challenges — provide
policymakers diverse opportunities to ask questions of policy
experts and share their knowledge with colleagues.