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Anatomical Gift Act

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DONATION PURSUANT TO THE CALIFORNIA UNIFORM ANATOMICAL GIFT ACT

(California Health and Safety Code 7150-7151)

In the event of my death, I donate the following part(s) of my body for the purposes identified in the California Health and Safety Code 7150-7151:

TISSUE:

Eyes

Bone and connective tissue

Skin

Heart

Other:

Limitations:

ORGAN:

Heart

Kidney(s)

Liver

Lung(s)

Pancreas

Other:

Limitations:

Signed this day of , , 20 .

Signature

Place

If another person is to sign for the declarant at the declarant's direction, the person signing for the declarant must sign in the presence of two witnesses. The witness form below may be used for the two witnesses. The acknowledgement form below may be used for the person qualified to take acknowledgements.

WITNESS FORM

The following witnesses declare that the signature above was made at the donor's request:

Witness Signature:

Witness Name:

Address:

Witness Signature:

Witness Name:

Address:

ADDITIONAL STATEMENT OF WITNESSES:

At least one of the above witnesses must also sign the following declaration:

I further declare under penalty of perjury under the laws of California that I am not related to the individual executing this advance health care directive by blood, marriage, or adoption, and to the best of my knowledge, I am not entitled to any part of the individual's estate upon his or her death under a will now existing or by operation of law.

Signature of Witness:

Signature of Witness:

A notary public or other office completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.

State of California

County of

On , 20 before me, (here insert name and title of the officer), personally appeared , who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his authorized capacity, and that by his signature on the instrument the person, or the entity upon behalf of which the person acted, executed the instrument.

I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.

WITNESS my hand and official seal.

Signature

(Seal)

Notary Public

Enter text✕

What the Anatomical Gift Act is and why it matters

The Anatomical Gift Act is the statutory framework that governs the donation of body parts, tissues, and whole bodies for transplantation, education, research, and therapy. It defines who may make a gift, which organs or tissues may be donated, how consent is documented, and how gifts are prioritized and allocated. Most U.S. jurisdictions implement a version of the Uniform Anatomical Gift Act or similar state statute; state law controls execution requirements and donor registries. Clarity in the gift document reduces family disputes and supports timely clinical or research use.

Why a clear Anatomical Gift Act document matters

A properly completed Anatomical Gift Act directive ensures donor intent is documented, legal authority is clear, and downstream medical or research teams can proceed without delay. It also helps families and authorized agents follow the donor's stated wishes.

Why a clear Anatomical Gift Act document matters

Who completes or relies on Anatomical Gift Act forms

Several parties interact with anatomical gift documents; each role has distinct responsibilities during completion and after death.

  • Donors and individuals: Use the form to record specific donations, designate donors, and define scope of gifts.
  • Healthcare and transplant coordinators: Verify consent, confirm identity, and initiate procurement steps.
  • Legal representatives and family members: Confirm authority and assist with execution when the donor lacks capacity.

Clear roles and written directives reduce ambiguity during time-sensitive clinical decision-making and allow lawful transfer consistent with state statute.

Step-by-step: Completing an Anatomical Gift form

Use this sequential checklist to prepare, complete, and preserve a legally effective anatomical gift directive.

  • 01
    Prepare ID: Gather government ID and medical information for accuracy.
  • 02
    Select gifts: Choose specific organs, tissues, or full-body donation options.
  • 03
    Designate agent: Name an agent or next of kin and include contact details.
  • 04
    Sign and date: Sign in required format and record effective date.

How the Anatomical Gift Act process typically flows

A concise overview of the typical workflow from signed directive to donation action.

  • Registration: Donor registers intent with state registry or completes written form.
  • Verification: Medical team verifies identity and checks registry at time of death.
  • Authorization: Procurement organization confirms scope and obtains medical clearances.
  • Procurement: Tissues/organs are recovered per medical and regulatory protocols.

Essential elements every professional Anatomical Gift form should include

A compliant form combines clear donor intent, authorized signers, scope of donation, and execution mechanics to meet state statute and clinical needs.

Donor identity

Full legal name, date of birth, and contact details to match medical records and registry entries for reliable identification.

Specific gifts

A list of organs or tissues authorized for donation, including options for therapeutic, research, or educational use.

Agent designation

Name and contact of a person authorized to make decisions or confirm donor intent when needed.

Execution clause

A statement confirming the donor's deliberate and informed decision to donate, signed and dated per state rules.

Revocation terms

Clear instructions about how to revoke the gift during the donor's life and any form or registry steps required.

Witness/notary

Lines to record witness signatures or notary acknowledgment if the state or institution requires it.

Privacy, security, and compliance considerations

HIPAA compliance: Protect PHI; follow 45 CFR §164.502–§164.534
Secure storage: Encrypted storage and limited access controls
Audit trail: Record who accessed or amended the directive
Encryption standards: TLS 1.2/1.3 in transit; AES-256 at rest
BAA availability: Business associate agreement required for PHI workflows
ESIGN/UETA: Electronic acceptance governed by 15 U.S.C. §7001 and UETA

Common preparation and execution pitfalls to avoid

  • Incomplete identity details that prevent registry matching and delay procurement decisions at time of death.
  • Ambiguous scope language such as "some tissues" without specification, which can lead to refusal by procurement organizations.
  • Missing or improper witness/notary where state law requires notarization or witness attestation for donor directives.
  • Failure to record revocations or updates in the state registry after changes in donor intent.

Legal risks and consequences of defective donor directives

Invalid consent: Gift may be void if execution fails to meet state statute
Family challenges: Surviving relatives may contest unclear directions
Processing delays: Unclear forms can delay or prevent timely donation
Regulatory noncompliance: Potential institutional liability for mishandled PHI
Criminal exposure: Fraudulent signatures can carry criminal penalties
Reputational harm: Improper handling undermines public trust

How to configure an online anatomical gift workflow

Typical configuration settings for a digital form and eSignature workflow used by hospitals or registries.

Field Configuration
Donor identity fields Required; validate with ID match
Scope selection Checkboxes with required selection
Agent contact Optional but recommended
Signature capture Audit trail plus timestamp required

Digital signing and platform requirements

When using eSignature for Anatomical Gift Act directives, ensure the platform supports legal, security, and audit requirements.

  • Authentication: Email, SMS, or stronger methods
  • Audit capabilities: IP, timestamp, and signer log
  • Integrations: Registry and EHR connectors

Choose a platform that can produce a reproducible record consistent with ESIGN (15 U.S.C. §7001) and support HIPAA protections where PHI is involved.

eSignature vendor comparison relevant to Anatomical Gift Act workflows

Comparison of starting price and core features for common eSignature vendors used to collect and manage Anatomical Gift Act directives. signNow appears first per table convention.

signNow DocuSign Adobe Sign PandaDoc HelloSign
Starting Price $8/user/mo $15/user/mo $14/user/mo $19/user/mo $15/user/mo
Free Trial 7-day free trial Yes Yes Yes Yes
Bulk Send Yes Yes Yes Yes No
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes Yes Yes No No
Envelope Cap No cap 100 envelopes/user/year Varies by plan Varies by plan Varies by plan

Key milestones from directive completion to procurement

A sequential view of key stages and what to expect between signing and potential use of the gift.

01

Form execution

Donor signs and dates the directive; record effective date and store securely.

02

Registry update

If applicable, enroll or update the state registry to reflect the directive.

03

Verification at death

Medical team checks registry and documents to confirm donor intent.

04

Procurement activation

Procurement organization confirms medical suitability and proceeds with recovery.

Frequently asked questions about completing and enforcing Anatomical Gift directives

Answers to common questions about validity, revocation, witnesses, and using eSignature for Anatomical Gift Act documents.


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