Legislation brings new Arizona Record for Donation of Anatomical Gifts Form

On August 25, 2004 a revision to the Arizona Uniform Anatomical Gift Act will take affect. Passed by the Arizona legislature earlier this year, the revisions add new requirements to the consent process for anatomical gifts, i.e. organs and tissue. The revisions are as follows:

1. A copy of the consent form must be provided to the legal consenting party.
2. The consenting party must be given notice of their right to have a third party present. This third party can be a family member, friend or other witness.
3. In addition to the signed consent for donation, the consenting party must document his / her initials next to each intended anatomical gift(s) to demonstrate acknowledgement and approval.
4. The consent form must reflect the date, time and location of the donation offer and decision and the name of a third party if they are present.
5. When consent for anatomical gift(s) occurs by telephone, the requestor must record the conversation and offer a copy or transcript of the conversation to the consenting party.

Donor Network of Arizona may still perform the consent request on behalf of hospitals. We will continue with our practice of recording all telephone consents. We will send a copy of the consent form to the person giving consent and will also provide a transcript or copy of the recorded conversation, if requested.

To assist hospitals in meeting these new regulations, Donor Network of Arizona (DNA) worked with the Arizona Hospital and Healthcare Association to provide a new consent form. In addition to reflecting compliance with the new Arizona statutes, this new consent form continues to allow hospitals to demonstrate compliance with CMS Conditions of Participation regulations for organ and tissue donation and JCAHO accreditation standards. Donor Network of Arizona is happy to provide you with NCR forms at no cost, or you can order them through Moore Wallace by contacting AuraLee Martinez at 888-665-2600 X 4944.

Revised Consent Form Template

Explanation of Proposed Form Changes

The attached forms represent proposed changes to the Arizona Record of Anatomical Gift Decisions. This form meets requirements as passed into law by the Arizona legislature this past session. These requirements include, a copy to be provided to the family, initialing of each anatomical gift, notification of right to a third party present and documentation of the date, time and location of the request, amendments to the form and any third party witness. The following explains additional things that are different from the previous form:

Two Forms
As you will see this form has been separated into two different forms. (Each page would be 8 1/2 x 11). The previous form provided two functions:

1. Documentation of Death or Imminent Death notification (per Conditions of Participation in Medicare)
2. Consent Form for the purposes of donation (Uniform Anatomical Gift Act).

While these forms will be held in one packet we felt it was important to separate them to accommodate the following:

• The new forms will be NCR forms so that family members can retain a copy of the signed consent form. We often have donor families who do not remember specifically what they consent to as they provide this consent in a time of grief. In addition, per the National Kidney Foundation Donor Family Advocacy Group, it is recommended that donor families be provided a copy of this form. (The form would actually be 3-part and DNA would retain one portion. The original would be placed in the hospital chart. DNA is willing to pay for the cost of these forms).
• We would like to give specific instructions to the Trained Designated Requester in the hospital about approach, and don’t necessarily feel it is appropriate to provide this information to the family.
• At the time of the initial notification to DNA from the hospital, we medically screen the patient and provide information back to the person who will be approaching the family as to what can be donated. When only having one set of check boxes to indicate what can be donated and what the family agrees to donate – we often cause a great deal of confusion as to what consent was given for. This entirely separates the process.
• The current form includes most elements of informed consent on the back of the form. Many times, this information is overlooked and not completed which requires DNA staff to re-approach the family to request consent. In moving these items to the front – with the notification piece on the consent form -- it made the form even smaller and harder to read.
• You may note that the lines for initialing are not lined up. This is on purpose in order to distinguish the initialed lines from non-initialed lines.

Informed Consent
The elements of informed consent have been changing over the past few years, and this consent form incorporates those changes. The Association of Organ Procurement Organizations, American Association of Tissue Banks and The Eye Bank Association of American collaborated on industry-wide recommended elements of informed consent in 2000. To incorporate these elements, DNA has alerted family members to these additional items at the time of our Medical and Social Screening Interview. If the family changes their mind based on this information we do not recover the tissue and / or organs. Due to time constraints it is sometimes necessary to recover eyes before this conversation takes place. If the family rescinds consent based on the additional information, we have to destroy the tissue.

Donor Registry
This form incorporates the step of checking and documenting donor registry status based on the addition of the registry to the Arizona Revised Statutes Uniform Anatomical Gift Act.

Translators
This form requires the signature of any translators used in the request process.

Any questions or comments should be directed to Shirley Miller (602) 222-2278, shirley@dnaz.org or Sara Pace Jones, (602) 222-2264, sara@dnaz.org