Rules & Regulations

Iowa Law: Pro­nounc­ing Death

Accord­ing to Iowa law, death is deter­mined when based on ordi­nary stan­dards of med­ical prac­tice, that per­son has expe­ri­enced an irre­versible ces­sa­tion of spon­ta­neous res­pi­ra­to­ry and cir­cu­la­to­ry functions.

In the event that arti­fi­cial means of sup­port pre­clude a deter­mi­na­tion that these func­tions have ceased, a per­son will be con­sid­ered dead if in the announced opin­ion of two physi­cians, based on ordi­nary stan­dards of med­ical prac­tice, that per­son has expe­ri­ence an irre­versible ces­sa­tion of spon­ta­neous brain func­tions. Death will have occurred at the time when the rel­e­vant func­tions ceased.

Iowa Death Law

Uni­form Anatom­i­cal Gift Act

The UAGA estab­lished first per­son con­sent that allows an indi­vid­ual to legal­ly record his or her dona­tion deci­sion. In Iowa, any doc­u­men­ta­tion of gift (i.e. ​“Donor – Y” on a driver’s license, reg­istry on the Iowa Donor Reg­istry, liv­ing will, etc.) is legal­ly bind­ing and does not require the con­sent of any oth­er person.

Iowa Donor Net­work encour­ages indi­vid­u­als to share and dis­cuss their dona­tion deci­sion with their fam­i­ly and loved ones. 

Dis­clo­sure under HIPAA

Cov­ered enti­ties under the Health Insur­ance Porta­bil­i­ty and Account­abil­i­ty Act of 1996 may use or dis­close pro­tect­ed health infor­ma­tion to enti­ties engaged in the recov­ery of organs, eyes, or tis­sue for the pur­pose of facil­i­tat­ing organ, eye or tis­sue dona­tion and transplantation.

CMS Con­di­tions of Par­tic­i­pa­tion: Organ, tis­sue, & eye donation

Cen­ter for Medicare and Med­ic­aid Ser­vices Con­di­tions of Par­tic­i­pa­tion stan­dards state that hos­pi­tals must:

• Have and imple­ment an agree­ment with the des­ig­nat­ed organ recov­ery agency under which it must noti­fy, in a time­ly man­ner, the organ recov­ery agency of indi­vid­u­als whose death is immi­nent or who have died in the hospital.
• Incor­po­rate an agree­ment with at least one tis­sue bank and at least one eye bank to coop­er­ate in the retrieval of tis­sues and eyes.
• Ensure, in col­lab­o­ra­tion with the OPO, that the fam­i­ly of each poten­tial donor is informed of its options to donate organ, tis­sues, or eyes or to decline to donate. The indi­vid­ual des­ig­nat­ed by the hos­pi­tal to ini­ti­ate the request to the fam­i­ly must be an organ dona­tion representative.
• Encour­age dis­cre­tion and sen­si­tiv­i­ty with respect to the cir­cum­stances, views, and beliefs of the fam­i­lies of poten­tial donors.
• Work coop­er­a­tive­ly with the organ recov­ery agency in edu­cat­ing staff on dona­tion issues, review­ing death records to improve iden­ti­fi­ca­tion of poten­tial donors, and main­tain­ing poten­tial donors while nec­es­sary test­ing and place­ment of poten­tial donat­ed organs, tis­sues, and eyes take place.

CMS Con­di­tions of Par­tic­i­pa­tion: Organ, Tis­sue, and Eye Procurement

CMS Inter­pre­ta­tive Guidelines

The Joint Commission

The Joint Com­mis­sion has estab­lished stan­dards for par­tic­i­pat­ing hos­pi­tals which include that:

• The hos­pi­tal has a writ­ten agree­ment with an OPO and at least one tis­sue bank and at least one eye bank.
• The hos­pi­tal must work with the OPO, tis­sue bank, and eye bank to (1) review death records, (2) main­tain poten­tial donors while nec­es­sary test­ing and place­ment of poten­tial donat­ed organs, tis­sues, and eyes takes place, (3) edu­cate staff about issues sur­round­ing dona­tion, and (4) devel­op a writ­ten pol­i­cy that address­es oppor­tu­ni­ties for asys­tolic recovery.
• Edu­ca­tion includes train­ing in use of dis­cre­tion and sen­si­tiv­i­ty to fam­i­lies of poten­tial donors.
• The indi­vid­ual des­ig­nat­ed by the hos­pi­tal to noti­fy the fam­i­ly regard­ing the option to donate or decline to donate is an organ dona­tion specialist.
• The hos­pi­tal noti­fies the OPO of patients who have died and of mechan­i­cal­ly ven­ti­lat­ed patients whose death is imminent.
• The OPO deter­mines med­ical­ly suit­abil­i­ty of organs for organ donation.
• The hos­pi­tal main­tains records of poten­tial organ, tis­sue, and eye donors whose names have been sent to the OPO and tis­sue and eye banks.

DNV GL NIA­HO — Nation­al Inte­grat­ed Accred­i­ta­tion for Health­care Organization

The DNV has estab­lished stan­dards for par­tic­i­pat­ing hos­pi­tals which include that:

• The orga­ni­za­tion shall have a process in place for the pro­cure­ment of organs, tis­sues, and eyes. The orga­ni­za­tion shall have an agree­ment with at least one tis­sue bank and one eye bank.
• The writ­ten agree­ment should include (1) pro­to­cols to ensure time­ly noti­fi­ca­tion to the OPO for all indi­vid­u­als whose death is immi­nent or who have died; (2) ensure com­mu­ni­ca­tion of the pol­i­cy to all appro­pri­ate areas of the orga­ni­za­tion; (3) acknowl­edge that it is the OPO’s respon­si­bil­i­ty for deter­mi­na­tion of med­ical suit­abil­i­ty; (4) ensure that the fam­i­ly or each poten­tial donor is informed of its options to donate organs, tis­sues, or eyes, or decline to donate; (5) ensure that the indi­vid­ual des­ig­nat­ed by the hos­pi­tal to ini­ti­ate the request to the fam­i­ly must be an organ dona­tion spe­cial­ist; and (6) ensure that it works coop­er­a­tive­ly to edu­cate staff on dona­tion issues, review death records, and main­tain poten­tial donors while nec­es­sary test­ing and place­ment of poten­tial donat­ed organs, tis­sues, and eyes take place.

Guide­lines for EMS Provider Ini­ti­at­ing Organ & Tis­sue Donation

Appen­dix J of the Statewide EMS TREAT­MENT PRO­TO­COLS for ADULT & PEDI­ATRIC encour­ages med­ical exam­in­ers or a med­ical examiner’s designee, peace offi­cers, fire fight­ers, and emer­gency med­ical care providers to con­tact Iowa Donor Net­work to ini­ti­ate organ and tis­sue dona­tion fol­low­ing the pro­nounce­ment of a death.