Personal Venture — NC Organ-Donation Nonprofit & Founder Toolkit

Organ & Tissue Donation: The US System, Policy, and NC Specifics

Educational domain reference for a North Carolina cause venture working on organ, eye, and tissue donation awareness and donor registration. It explains how the system is structured and governed, how people register, the major policy debates, the myths and equity barriers a campaign must navigate, and the NC-specific law and registry mechanics. It is a knowledge foundation, not medical or legal advice — see the Disclaimer, and always re-verify live numbers and law before publishing.

Quick framing for a venture: in the US you cannot “make” anyone a donor and you do not run the recovery or matching — that is the OPO and OPTN’s job. A donation-awareness nonprofit’s real levers are education, myth-correction, trust-building, and driving registry sign-ups (especially in under-registered communities). Keep that scope in mind throughout.

A note on vocabulary: the field’s preferred phrase is “organ, eye, and tissue donation” (eyes/corneas are tracked separately from other tissue). Say “deceased donor,” not “cadaveric”; say “recover/recovery,” not “harvest.” “Donor” registration normally means deceased donation; living donation is arranged separately.

1. The US donation & transplant system and its oversight

The US system is a public-private structure created by the National Organ Transplant Act (NOTA) of 1984, which banned the sale of organs and established the national network.

• HRSA (Health Resources & Services Administration) — the HHS agency that oversees the OPTN via federal contract and runs the public-facing education site organdonor.gov (organdonor.gov; HRSA). HRSA sets the rules of the road; it does not itself match organs.
• OPTN (Organ Procurement and Transplantation Network) — the national transplant system mandated by NOTA. The OPTN sets allocation policy, operates the matching technology, and collects the data. Membership includes transplant hospitals, OPOs, and labs (optn.transplant.hrsa.gov).
• UNOS (United Network for Organ Sharing) — a private nonprofit that held the sole OPTN contract from 1986 until 2023-2024. UNOS built and ran the matching system (UNet) and supported OPTN policy work. As of 2024-2025 UNOS is one contractor among others (see Modernization below) (UNOS.org).
• SRTR (Scientific Registry of Transplant Recipients) — the analytics arm that publishes program- and OPO-level outcome statistics used in policy and public reporting.

The 2023-2024 OPTN Modernization Initiative (important and ongoing)

After 2022 Senate Finance Committee scrutiny and reports of system failures, HRSA launched the OPTN Modernization Initiative in March 2023 to break UNOS’s monopoly and introduce competition.

• Congress passed the Securing the U.S. OPTN Act (Public Law 118-14, signed Sept. 2023), which removed the statutory language that had effectively limited the OPTN to a single contractor and let HRSA award multiple contracts for separate functions — IT, operations, board support, etc. (HRSA OPTN Modernization; The Regulatory Review, 2024-06-04).
• UNOS’s long-standing sole contract ended March 29, 2024. UNOS signed a short-term contract effective March 30, 2024 (a base period plus option extensions) and has continued in a reduced role under extensions (UNOS, “UNOS and HRSA agree on new short-term OPTN contract”).
• Board independence: In 2024 the OPTN Board of Directors was separated from UNOS to remove the conflict of interest where the contractor also governed the network; an independent OPTN board structure is being stood up (HRSA; OPTN public comment on OPTN/contractor board relationship).
• Functions being competed out: HRSA is splitting OPTN functions across vendors. Patient-safety and committee-support functions were slated to leave the UNOS contract and be competed in early 2026, per the multi-vendor plan (HRSA OPTN Modernization updates, Nov. 2025). Expect continued churn in who runs what through 2026 — verify current contractor assignments before stating them.

Takeaway for a venture: the registration and education layer (DMV, Donate Life, organdonor.gov) is stable; the governance/contractor layer is mid-restructuring. Don’t pin messaging to “UNOS runs the system” — say “the OPTN, overseen by HRSA.”

2. Organ Procurement Organizations (OPOs) and CMS performance rules

OPOs are the nonprofits that do the on-the-ground work of deceased donation: responding to hospital referrals, evaluating potential donors, obtaining authorization, coordinating recovery, and getting organs to transplant centers. There are roughly 55 federally designated OPOs, each assigned an exclusive geographic Donation Service Area (DSA) (organdonor.gov; HonorBridge). Hospitals are required by federal law to refer all imminent deaths to their OPO.

OPOs are reimbursed through Medicare and regulated by CMS (Centers for Medicare & Medicaid Services) under “Conditions for Coverage.”

The 2020 CMS OPO Final Rule (the accountability shake-up)

On November 20, 2020, CMS finalized a rule (effective for the cohort starting 2022, with consequences landing in 2026) that replaced self-reported OPO metrics with objective, claims-based outcome measures — a donation rate and a transplantation rate, benchmarked against all OPOs (CMS Fact Sheet, 2020-11-20). It created a three-tier system with non-overlapping performance bands (an OPO’s tier is set by its worse of the two rates relative to the national distribution):

Analysts have warned that a large share of OPOs (estimates around 42%) could face decertification/competition in the 2026 recertification cycle — a real risk of disruption that the industry (AOPO) has pushed back on (AOPO; Applied Policy; Crowell & Moring). In January 2026 CMS issued a proposed rule offering additional guidance — e.g., an OPO assigned at least one Tier 1 or Tier 2 DSA would not be treated as out of compliance with Conditions of Participation on outcomes alone (Holland & Knight, 2026-03; Crowell & Moring). [UNVERIFIED — status as of mid-2026 is in flux; verify the final rule and 2026 cycle outcomes before publishing.]

Why it matters for NC: NC’s OPOs operate under this regime, and there has been active DSA “turf” conflict in NC (see §9). A venture should understand that OPO performance and territory are contested and politically live.

3. Donor registration pathways

Registering is a declaration of intent to be a deceased organ, eye, and tissue donor. In the US it is opt-in and, for adults, first-person authorization (legally binding — see §7). Main pathways:

• State donor registries — every state has one. This is the authoritative legal record an OPO checks at time of death.
• DMV / motor-vehicle sign-up — the dominant channel. When you get or renew a license/ID, you’re asked to join; saying yes adds a heart symbol to the card and enters you in the state registry. DMV and driver-license partners have helped roughly 165 million people register through that channel — a subset of the ~170 million total registered donors across all channels (Donate Life America).
• Donate Life America (DLA) — the national nonprofit coalition that brands “Donate Life,” runs National Donate Life Month (April), and operates the National Donate Life Registry at RegisterMe.org, launched 2015 (donatelife.net).
• National Donate Life Registry — a national, mobile-friendly registry that syncs registrations and is accessible to OPOs nationwide. Also reachable via the Apple Health app (iPhone) and, increasingly, MyChart/Epic patient portals — DLA reported in December 2025 that 130,000+ people registered via MyChart, and that nearly half of recent new registrations came through MyChart (Donate Life America, 2025).
• organdonor.gov — HRSA’s hub that routes people to their state/registry sign-up and hosts educational content.

For a venture, the practical message is: “Sign up at the DMV, online at your state registry or RegisterMe.org, or in your phone’s Health app — it’s free and you can specify your wishes.” Online registration often lets people specify or exclude organs/tissues; the DMV heart is broader but simpler.

4. Living vs deceased donation

Deceased donation is the large majority of transplants and the focus of “donor registration.” A single deceased donor can save up to 8 lives (organs) and enhance up to ~75 more through tissue/eye donation (organdonor.gov). Roughly 30,000 tissue donors contribute each year; corneal transplant success rates exceed 95% (organdonor.gov).

Living donation — a healthy person donates a kidney or a portion of liver (and rarely lung lobe or other tissue) while alive. In 2024, about 7,030 living donors made roughly 7,000 living-donor transplants — about 15% of the year’s 48,149 total (about 6,400 living-donor kidneys and ~600 living-donor livers) (OPTN/UNOS 2024 data; Donate Life America). (Some sources cite ~18% against a smaller transplant base; the figure here is computed against the 48,149 topline used throughout this skill.) Types:

• Directed — to a specific known recipient (most living donations).
• Non-directed / altruistic (“Good Samaritan”) — to a stranger; a small minority of living donors (OPTN/UNOS 2024 data).
• Paired exchange / kidney paired donation (KPD) — when a willing donor isn’t a match for their intended recipient, pairs (or chains) are swapped so each recipient gets a compatible kidney. The National Kidney Registry organizes most large US swaps (National Kidney Registry; Donate Life America). DLA in 2025 launched a two-year national pilot to support living kidney donation via a Living Donor Pathway (donatelife.net, 2025).

Living donation is arranged through transplant centers, not the deceased-donor registry — a useful distinction when a campaign gets “how do I donate a kidney to my relative?” questions.

5. DBD vs DCD (donation after brain vs circulatory death)

Two legal pathways for declaring death in deceased donation:

• DBD — Donation after Brain Death: the donor is declared dead by neurological criteria (irreversible cessation of all brain function) while the heart still beats on support. Historically the larger pathway; organs are recovered with circulation maintained until recovery.
• DCD — Donation after Circulatory Death: the donor has a non-survivable injury but does not meet brain-death criteria; after a planned withdrawal of life support and irreversible cessation of circulation, death is declared and organs are recovered. Both are governed by the dead-donor rule (recovery does not cause death).

DCD has grown rapidly. In 2024 there were ~7,280 DCD donors, up ~23.5% over 2023 (OPTN/UNOS; The Organ Donation Alliance). Two enabling technologies drove this:

• Normothermic Regional Perfusion (NRP) — restoring oxygenated blood flow in situ to target organs after circulatory-death declaration, improving organ viability (used increasingly since ~2019).
• Ex-vivo normothermic machine perfusion — keeping organs functioning outside the body; FDA-relevant approval for livers around 2021 and enabling DCD heart transplantation from ~2019 (peer-reviewed cardiac/liver/lung series, PMC, 2024-2025).

Studies through 2024-2025 generally show NRP-assisted DCD outcomes comparable to DBD for heart, liver, and lung (PMC/PubMed, 2024-2025). NRP is also ethically debated (concerns about restoring circulation after death declaration) — worth knowing if a campaign touches the “how death is determined” myth space (see §8).

6. The waitlist, allocation, and continuous distribution

The waitlist: Over 100,000 people are on the US transplant waiting list (the field commonly cites “~103,000+”; ~85-90% are waiting for kidneys). Someone is added roughly every 8-10 minutes, and on the order of ~13-17 people die each day waiting (figures vary by source and year — pull current numbers from the OPTN dashboard, organdonor.gov). In 2024 the US performed a record 48,149 transplants (+3.3% over 2023), enabled by 16,988 deceased donors and 7,030 living donors (OPTN/UNOS, Jan. 2025).

Allocation basics: organs are matched to candidates by medical and logistical factors — blood/tissue type, organ size, medical urgency, time on the list, geographic/logistical proximity, and pediatric status. There is no payment and no preference by race, gender, income, or celebrity; the matching is run by the OPTN system. Geography historically used fixed DSA/region boundaries.

Continuous Distribution — the OPTN’s current modernization of how organs are allocated. It replaces hard geographic boundaries and rigid tiers with a single weighted “composite allocation score,” combining attributes (medical urgency, candidate biology, expected benefit, access/equity, proximity/efficiency) into points so no single factor is an absolute cutoff (HRSA: Continuous Distribution; optn.transplant.hrsa.gov). Rollout is organ-by-organ:

• Lung — continuous distribution went live March 9, 2023 (first organ).
• Kidney/Pancreas, Heart, Liver/Intestine — in development/phased through 2024-2026; heart and liver/intestine proposals and public comments were active in 2025. A comprehensive multi-organ allocation policy was out for public comment in 2025 (HRSA public comment pages, 2025).

For a venture: continuous distribution is the headline allocation reform; “lung is done, the rest are rolling out” is the accurate one-liner. Verify which organs have gone live before stating specifics.

7. Consent models & the opt-in vs opt-out debate

The US model is opt-in with first-person authorization. Under the Revised Uniform Anatomical Gift Act (RUAGA, 2006) adopted in most states (including NC), a competent adult’s registered “yes” is a legally binding gift that only the donor can revoke (Donor Alliance; PMC). In practice this means that when a registered adult dies and becomes medically eligible, the law treats the family as informed, not asked — the donor already gave consent. (OPOs still work closely and compassionately with families; honoring first-person authorization over family objection is legally supported but handled sensitively.) If a person never registered, the OPO seeks authorization from the next of kin / legally authorized representative.

Opt-out / “presumed consent”: the alternative model (used in e.g. the UK, Spain, and much of Europe) where everyone is presumed a donor unless they register a refusal. Spain’s high donation rate is often cited for opt-out — but Spain’s success is widely attributed to its OPO infrastructure and in-hospital coordinators (“the Spanish Model”), not the legal default alone.

The evidence and US debate: systematic comparisons find that switching the legal default, by itself, has little reliable effect on actual donation/transplant numbers; system investment (OPO performance, hospital coordination, family approach) matters more (PMC review, “Opt-In vs Opt-Out”; The Organ Donation & Transplantation Alliance). Analysts generally conclude that moving the US to opt-out would not by itself make more organs available, and could even erode public trust if perceived as coercive. The US has therefore pursued better systems and registration rather than presumed consent. A myth to preempt: claims that “the government will take your organs without consent” — false; US donation is opt-in and consent-based.

8. Myths, barriers & faith/cultural considerations

A donation-awareness venture lives or dies on myth-correction and trust, especially in communities with lower registration. Common myths and the factual responses:

• “If I’m a registered donor, ER doctors won’t try as hard to save me.” False. The medical team treating you is separate from the donation/transplant team, and donation is only considered after death is declared and all life-saving efforts have failed (Mayo Clinic; organdonor.gov).
• “I’m too old / too sick to donate.” Mostly false. There is no strict age cutoff; medical suitability is assessed at the time of death. Most conditions don’t automatically rule you out.
• “My religion prohibits it.” Almost always false. Most major religions support or permit donation as an act of charity — Catholicism, most Protestant denominations, most branches of Judaism, and Islam generally permit it; positions are often simply unknown, which lets myths fill the gap (PMC; organdonor.gov). Clergy engagement is an evidence-supported intervention.
• “An open-casket funeral won’t be possible.” False. Recovery is done surgically and respectfully; open-casket services remain possible.
• “It costs the family money” / “the rich can buy their way up the list.” False on both. The donor’s family is not charged for donation, and selling organs is illegal under NOTA; allocation ignores wealth and status.

Equity and structural barriers (central to NC and US work):

• Racial disparity: Black/African Americans are roughly 27-30% of the waiting list but only ~13-14% of donors (HHS Office of Minority Health, 2025; organdonor.gov). Because organ/tissue matching (especially kidney) is more likely within similar genetic backgrounds, under-registration in a community lengthens waits for that community.
• Distrust of the medical system — rooted in real historical harms (e.g., the Tuskegee study) — is repeatedly identified as a leading barrier among African Americans, alongside lack of awareness and religious misperception (PMC, multiple studies). Trust-building, community/clergy partnership, and culturally grounded messaging are the evidence-based responses, not blame or guilt framing.
• Cultural/linguistic access — materials and outreach in-language and via trusted community institutions outperform generic campaigns.

Messaging guidance for a venture: lead with agency, accuracy, and altruism, name and correct the specific myth, partner with trusted messengers (faith leaders, community orgs, patient/recipient voices), and avoid fear or coercion framing (which can backfire and feed the opt-out distrust narrative).

9. North Carolina law & registry

The NC Revised Uniform Anatomical Gift Act

NC adopted the Revised Uniform Anatomical Gift Act, codified at NC General Statutes Chapter 130A, Article 16 (GS 130A-412.3 et seq.) (ncleg.gov). Key provisions a venture should know:

• Who & how to make a gift (GS 130A-412.7, “Manner of making an anatomical gift before death”): a donor may make a gift by (a) authorizing a statement/symbol on the driver’s license or ID, (b) a signed donor card or other signed record, (c) inclusion in a donor registry, (d) a will, or (e) during terminal illness/injury, by communication to at least two adults, one a disinterested witness (ncleg.gov, GS 130A-412.7). The statute has been amended several times — 2007-538, 2019-143, 2021-32, and 2025-60 — so cite the current version.
• DMV-method limitation: a gift made only via the license/ID symbol does not by itself include the donor’s body (i.e., the heart on the card covers organ/eye/tissue, not whole-body/anatomical-board donation) (GS 130A-412.7).
• Income-tax election (new): an amendment adds the ability to make an anatomical gift by election on a NC state income tax return (per GS 105-153.8A), effective January 1, 2027 (ncleg.gov). [UNVERIFIED — effective date and mechanics; verify against the enacted text before relying on it.]
• First-person authorization is binding: consistent with RUAGA, an adult NC registrant’s gift is legally binding and revocable only by the donor; hospitals’ obligations and family interactions follow Article 16.
• Hospital referral duty: NC law requires hospitals to notify the appropriate organ, eye, and tissue recovery agency when a person dies or death is imminent (NC Secretary of State; Article 16). This is how OPOs learn of potential donors.

NC donor registry mechanics

• The registry: the NC Division of Motor Vehicles (NC DMV) is partnered with Donate Life NC to maintain “the only online database of registered organ donors” in NC (NC Secretary of State). Donate Life NC (donatelifenc.org) is the state’s donation-education affiliate and the public face of the registry.
• Three ways to register in NC: (1) at the DMV when getting/renewing a license or ID; (2) online at donatelifenc.org (you’ll need your NC driver’s license/ID number); (3) in the Apple Health app on iPhone (Donate Life NC).
• DMV must ask: by NC law the DMV is required to ask all drivers age 16 and older whether they want to join the registry; saying yes adds a red heart to the license/ID (Donate Life NC).
• Minors vs adults: a person 16-17 can have the heart, but parents retain the right to make the final decision; at 18 the heart becomes legally binding first-person consent (Donate Life NC).
• Online lets you specify wishes: registering online (vs the DMV heart) lets you choose or exclude specific organs/tissues (Donate Life NC).
• Advance directive nuance: filing a Declaration of an Anatomical Gift in the NC Secretary of State’s Advance Health Care Directive Registry is not accessible to the DMV or Donate Life NC registry — the SOSNC advises also registering with Donate Life NC or the DMV so recovery agencies can find your wishes (NC Secretary of State).

NC’s OPOs (two serve the state — important)

NC is split between two federally designated OPOs by territory:

• DSA conflict: the two OPOs and CMS have been in active territory disputes (e.g., litigation over the Winston-Salem / Lexington Medical Center area in 2025-2026, tied to the CMS rule), so service-area boundaries can shift — verify current DSA assignments (HonorBridge press release, 2025; NC Health News, 2025-03; Federal Register, 2026-02).

NC also has a whole-body/anatomical donation path (for medical education/research) handled separately via medical schools / a state anatomical program — distinct from the organ/eye/tissue registry above. [UNVERIFIED — NC anatomical-board specifics not deeply verified here; confirm before advising donors on whole-body donation.]

10. Data sources (pull current numbers from these)

Statistics change yearly; always cite the as-of date and prefer these primary sources over secondhand blogs:

• OPTN national data — optn.transplant.hrsa.gov (waitlist, donors, transplants; the authoritative US numbers).
• HRSA Organ Donation & Transplantation Dashboard — data.hrsa.gov (national/state trends, OPO-level data).
• organdonor.gov — HRSA’s education hub and statistics summary (note: this site and hrsa.gov may block automated fetching; open in a browser).
• SRTR — srtr.org (program- and OPO-level outcomes).
• UNOS — unos.org (newsroom, annual totals, modernization updates).
• Donate Life America — donatelife.net (registry data, National Donate Life Month statistics PDF, living-donation pilots).
• CMS — cms.gov (OPO Conditions for Coverage final/proposed rules, performance reporting).
• NC: ncleg.gov (GS Ch. 130A Art. 16 statute text), donatelifenc.org (NC registry/FAQ), NC Secretary of State sosnc.gov (advance directive registry, DMV relationship), honorbridge.org and lifesharecarolinas.org (NC OPOs).

Confirmed reference figures used above (verify before republishing): 48,149 US transplants in 2024 (+3.3%); 16,988 deceased + 7,030 living donors (2024); ~7,280 DCD donors (2024, +23.5%); ~103,000+ on the waitlist; ~170 million registered US donors; ~55 OPOs; 1 donor → up to 8 lives + ~75 enhanced.

Sources

1. HRSA — OPTN Modernization Initiative, updates (Nov. 2025): https://www.hrsa.gov/optn-modernization/updates/november-2025
2. HRSA — Continuity of Patient Safety Activities for the OPTN: https://www.hrsa.gov/optn/news-events/news/continuity-patient-safety-activities-optn
3. UNOS — “UNOS and HRSA agree on new short-term OPTN contract”: https://unos.org/media-resources/releases/unos-and-hrsa-agree-on-new-short-term-optn-contract/
4. UNOS — “How UNOS’ role in the OPTN has changed under the additional contract extension”: https://unos.org/news/how-unos-role-in-the-optn-has-changed-under-the-additional-contract-extension/
5. The Regulatory Review — “Organ Transplantation System Modernization” (2024-06-04): https://www.theregreview.org/2024/06/04/organ-transplantation-system-modernization/
6. OPTN — Proposal to Address the Relationship of the OPTN and OPTN Contractor Boards: https://optn.transplant.hrsa.gov/policies-bylaws/public-comment/proposal-to-address-the-relationship-of-the-optn-and-optn-contractor-boards/
7. organdonor.gov — Organ Donation Statistics: https://www.organdonor.gov/learn/organ-donation-statistics
8. organdonor.gov — What Can Be Donated: https://www.organdonor.gov/learn/what-can-be-donated
9. HRSA/OPTN — “Organ Transplants Exceeded 48,000 in 2024; a 3.3 Percent Increase”: https://www.hrsa.gov/optn/news-events/news/organ-transplants-exceeded-48000-2024-33-percent-increase-transplants-performed-2023
10. The Organ Donation Alliance — “Organ transplants exceeded 48,000 in 2024”: https://www.organdonationalliance.org/article/organ-transplants-exceeded-48000-in-2024-a-3-3-percent-increase-from-the-transplants-performed-in-2023/
11. UNOS — “U.S. surpassed 48,000 organ transplants in 2024”: https://unos.org/media-resources/releases/u-s-surpassed-48000-organ-transplants-in-2024/
12. CMS — OPO Conditions for Coverage Final Rule fact sheet (2020-11-20): https://cms.gov/newsroom/fact-sheets/organ-procurement-organization-opo-conditions-coverage-final-rule-revisions-outcome-measures-opos
13. Applied Policy — CMS Updates Minimum Standards for OPOs (CMS-3380-F): https://www.appliedpolicy.com/cms-updates-minimum-standards-of-care-for-organ-procurement-organizations-including-revisions-to-outcome-measurements-cms-3380-f/
14. Crowell & Moring — What OPOs Need to Know About CMS’s New Proposed Rule (2026): https://www.crowell.com/en/insights/client-alerts/what-organ-procurement-organizations-need-to-know-about-cmss-new-proposed-rule
15. Holland & Knight — “CMS Issues Additional Guidance on the Organ Donation Process” (2026-03): https://www.hklaw.com/en/insights/publications/2026/03/cms-issues-additional-guidance-on-the-organ-donation-process
16. AOPO — “U.S. OPOs Recovered Record Number of Organs in 2024…”: https://aopo.org/us-organ-procurement-organizations-recovered-record-number-of-organs-in-2024-while-looming-federal-policies-jeopardize-patients/
17. HRSA — Continuous Distribution policy issue page: https://www.hrsa.gov/optn/policies-bylaws/policy-issues/continuous-distribution
18. HRSA/OPTN — Establish a Comprehensive Multi-Organ Allocation Policy (2025 public comment): https://www.hrsa.gov/optn/policies-bylaws/public-comment/establish-comprehensive-multi-organ-allocation-policy-2025
19. OPTN — Lung continuous distribution policy notice (PDF): https://optn.transplant.hrsa.gov/media/b13dlep2/policy-notice_lung_continuous-distribution.pdf
20. Donate Life America — National Donate Life Registry: https://donatelife.net/donation/donor-registries/national-donate-life-registry/
21. Donate Life America — “Leads National Registry Initiative” (MyChart/Epic, 2025): https://donatelife.net/news/donate-life-america-leads-national-registry-initiative/
22. Donate Life America — Living Donor Pathway / living kidney donation pilot (2025): https://donatelife.net/news/donate-life-america-launches-two-year-national-pilot-to-support-living-kidney-donation/
23. Federal Register — National Donate Life Month, 2025 proclamation: https://www.federalregister.gov/documents/2025/04/09/2025-06160/national-donate-life-month-2025
24. PMC — “Assessing Global Organ Donation Policies: Opt-In vs Opt-Out”: https://pmc.ncbi.nlm.nih.gov/articles/PMC8128443/
25. The Organ Donation & Transplantation Alliance — “Opt-In vs Opt-Out Donation Systems”: https://www.organdonationalliance.org/insight/opt-in-vs-opt-out-donation-systems/
26. Donor Alliance — “Presumed Consent or Opt-Out: What does it mean?”: https://www.donoralliance.org/newsroom/donation-essentials/presumed-consent-or-opt-out-what-does-it-mean/
27. PMC — “First-Person Authorization and Family Objections to Organ Donation”: https://pmc.ncbi.nlm.nih.gov/articles/PMC12097891/
28. PMC — “Changes in Organ Donation after Circulatory Death in the United States”: https://pmc.ncbi.nlm.nih.gov/articles/PMC12947068/
29. Circulation: Heart Failure — “DCD Heart Transplant: Current State and Future Directions”: https://www.ahajournals.org/doi/10.1161/CIRCHEARTFAILURE.124.011678
30. Mayo Clinic Health System — “Debunking organ donation myths”: https://www.mayoclinichealthsystem.org/hometown-health/featured-topic/organ-donation-dont-let-these-myths-confuse-you
31. HHS Office of Minority Health — “Organ Transplants and Black/African Americans”: https://minorityhealth.hhs.gov/organ-transplants-and-blackafrican-americans
32. PMC — “Distrust in the Healthcare System and Organ Donation Intentions Among African Americans”: https://pmc.ncbi.nlm.nih.gov/articles/PMC3489022/
33. PMC — “Understanding the Role of Clergy in African American Organ and Tissue Donation Decision-Making”: https://pmc.ncbi.nlm.nih.gov/articles/PMC3489162/
34. NC General Assembly — GS 130A-412.7 (Manner of making anatomical gift before death): https://ncleg.gov/EnactedLegislation/Statutes/HTML/BySection/Chapter_130A/GS_130A-412.7.html
35. NC General Assembly — Chapter 130A, Article 16 (Revised Uniform Anatomical Gift Act): https://www.ncleg.net/EnactedLegislation/Statutes/HTML/ByArticle/Chapter_130A/Article_16.html
36. Donate Life NC — Frequently Asked Questions: https://www.donatelifenc.org/content/frequently-asked-questions
37. Donate Life NC — Donor Registry: https://www.donatelifenc.org/content/donor-registry
38. NC Secretary of State — “Organ Donation and the North Carolina DMV”: https://www.sosnc.gov/divisions/advance_healthcare_directives/organ_donation_and_the_nc_dmv
39. HonorBridge — About Us: https://honorbridge.org/who-we-are/about-us/
40. HonorBridge — Sign up as a Donor (RegisterMe): https://honorbridge.org/registerme/
41. LifeShare Carolinas: https://www.lifesharecarolinas.org/
42. North Carolina Health News — “Turf war erupts over organ donation services” (2025-03-25): https://www.northcarolinahealthnews.org/2025/03/25/turf-war-erupts-over-organ-donation-services/

Disclaimer

This is general educational information, not medical or legal advice. It is intended to ground a donation-awareness venture’s understanding of the US and North Carolina donation systems — it does not establish a donor’s legal status, advise on a specific medical situation, or substitute for counsel on nonprofit, healthcare, or consent law. Donation policy, federal contracts/contractors, CMS rules, allocation policy, statistics, and NC statutes all change — several items here are mid-transition as of mid-2026 (OPTN modernization/contractors, the 2026 CMS OPO recertification cycle, continuous-distribution rollout by organ, the NC 2025-60 amendment and the 2027 tax-return method, and NC OPO service-area disputes). Always verify current details against primary sources — HRSA/OPTN (optn.transplant.hrsa.gov, hrsa.gov), organdonor.gov, CMS, the NC General Statutes (ncleg.gov), Donate Life NC, and the relevant NC OPO — before publishing claims, especially statutes, statistics, and citations. Items marked [UNVERIFIED] or with verification caveats above were not fully confirmed against a primary source in this draft.