New NC law will expand registration access for potential organ donors
North Carolinians will soon be able to register as organ donors when filing their state taxes — a move aimed at closing the gap between support for donation and the number of people actually enrolled.
But experts say the “Check Yes, Save Lives” initiative, which also allows residents to register as eye and tissue donors, is only the first step. The policy is set to take effect in 2027, and its success will depend on what happens in the meantime.
“It’s so important that North Carolinians get extra opportunities to sign up to be a donor,” said Danielle Bumarch, president and CEO of HonorBridge, the state’s largest organ procurement organization. “But this is just one piece of what we need to do.”
Signed into law earlier this month by Gov. Josh Stein, SB600 gives residents relying on infrequent visits to the Department of Motor Vehicles an annual opportunity to register as donors. That added access is critical, said Bumarch, who noted the state’s transplant waitlist is nearing 4,000 people.
Still, she said, medical mistrust remains a major barrier in communities with limited access to information about the donation process. Many North Carolinians believe registering as an organ donor gives healthcare professionals less incentive to save their life, some viewing the tiny red heart on their license as a reason they might never make it home.
“I had no idea that there was a system,” said Bob Curlee of Apex, a transplant recipient who helped advocate for the bill. “I’m just hoping the education is better because of this law passing.”
Curlee underwent a heart transplant in 2022, his final option after a lifelong battle with Hypertrophic Cardiomyopathy. Until then, he believed organs were snatched from accident victims without oversight. Without the surgery, Curlee said he still wouldn’t know how the transplant system works.
But most residents won’t experience the process. Transplantation is rarely witnessed even secondhand, with fewer than one percent of registered donor deaths resulting in organ donation. That rarity, experts say, is even more reason to educate people before they’re forced to make decisions.
“At that critical moment where they might need a team like ours, it’s such a gift for a family to know what somebody wanted to do instead of having the family grapple with what the right decision might be,” said Bumarch.
Sharing the stories of transplant recipients is one of the more powerful forms of education, said Dinushika Mohottige, a general nephrologist and health equity researcher who spent two decades in Durham and Chapel Hill. A former chief resident and nephrology fellow at Duke University School of Medicine, Mohottige said conversations with communities where medical mistrust is common can inform strategies that address the root causes of disparities in organ transplantation.
“We have to recognize that mistrust is often born of historic, lived, or vicarious experiences we have had within or outside of healthcare,” said Mohottige, now an assistant professor at the Icahn School of Medicine at Mount Sinai in New York. “Education campaigns really need to be tailored to all communities to ensure equitable uptake.”
A federal investigation released in May, prompted by the case of a man who reportedly shook his head as his organs were being prepared for removal, found that a Kentucky organ procurement group ignored signs of life in several patients authorizing retrieval attempts. The Health Resources and Services Administration found that the organization had overlooked signs of increasing consciousness in 73 potential donors.
And a New York Times report last week found that a growing number of patients have experienced premature or mishandled attempts at organ retrieval. The analysis cited an increasingly aggressive amount of donations after circulatory death, where medical teams deem patients beyond recovery, withdraw life support with family consent, and wait for the heart to stop before beginning organ procurement.
Paying attention to such incidents is essential, said Mohottige, as trust cannot exist without transparency. She said addressing failures within the system is critical to earning the respect of both donors and recipients, and to make sure new legislation is introduced responsibly.
“To ensure that a policy like this in North Carolina can really have the incredible impact that it was intended to have,” said Mohottige, “all of our words have to be aligned toward the mission of earning public trust.”
Bumarch said the spread of misinformation has only worsened since the COVID-19 pandemic, making it increasingly difficult to build public trust. In response, many nonprofits have launched targeted education initiatives.
She continues to stress that conversations about organ procurement begin only when death is imminent and hospital teams have exhausted all efforts to save the patient’s life. But the new legislation, Bumarch said, will create more opportunities to spread the word that organ procurement organizations are not involved until doctors and family have decided to end life-sustaining care.
“Since this does become active in 2027, that gives us a lot of time to prepare North Carolina,” she said. “We’re going to be doing a lot of work so people aren’t surprised.”
Wisconsin and Michigan, the only other states with similar laws, have seen tens of thousands of new donors register since their legislation passed. Experts from both states helped shape North Carolina’s bill, sharing outcome data and language that was later brought to lawmakers.
And future registration numbers will offer insight into the policy’s impact in the Tar Heel State. But regardless of the metrics, advocates say the updated tax form will include educational materials alongside the donor registration option, giving residents access to transplant information they may never have encountered otherwise.
“It would be good for the public to know that there’s a system and a standard,” said Curlee. “If we educate more people, then they’ll know that it’s safe.”
This story was originally published July 29, 2025 at 5:00 AM.
