Getting aggressive about organ donations

April 4, 2008

Why doctors need to discuss organ donations with patients

If a bill recently introduced in Delaware passes, state residents who suffer cardiac or brain death will become potential organ donors, whether that's what they intended or not.

Earlier this year, Rep. Pete Schwartzkopf, a Democrat from Rehoboth Beach, co-sponsored legislation in which residents would automatically be enrolled as an organ and tissue donor when applying for or renewing their driver's license-unless they check a box indicating that they do not wish to participate.

This opt-out model for organ donations, known as Presumed Consent, bucks the spirit of our current voluntary opt-in (Informed Consent) system. Presumed Consent changes the nature of the consumer's decision. It's more guilt-inducing-and harder-for consumers to actively choose not to help others in need than to passively let the opportunity to help slip by. Legislating an opt-out approach also implies that donating organs is the sanctioned social norm.

It's not likely that America would buy into to a "hard" opt-out system. If a Presumed Consent bill passed, it would probably allow a deceased's family to veto organ donations. And there would also be plenty of safeguards so that no one would accidentally become a donor through sheer oversight.

A 2005 study published in Transplant International looked at 10 countries with either Presumed or Informed Consent for organ donations, and concluded that opt-out doesn't guarantee higher donation rates. Other studies suggest that health education expenditures, death rates from accidents, and process and logistical issues may play a greater role.

Ways to ease the organ shortage

Still, something needs to be done to boost the number of organs available. According to The Organ Procurement and Transplantation Network, some 98,000 people in the US are on waiting lists for organs (including about 74,000 for kidneys, 16,000 for livers, and 2,700 for hearts). It's estimated that every 18 minutes, a patient dies for lack of an available organ.

Educating the public about the importance of organ donation may be the most reasonable approach. As a physician, you're in an ideal position to ask patients if they've considered donation and to answer their questions and allay their fears. While some doctors worry that introducing the topic increases patients' concerns about their health, others make it a routine part of well visits. You can explain that because of the huge shortage, you routinely ask this of all patients.

Last year, Texas physicians began a pilot program to do just that. Sponsored by The Health Resources and Services Administration (HRSA) and the Organ Procurement and Transplantation Network, the program provides material that encourages patients to think more about, and talk to their doctors about, organ donation. Results are currently being evaluated.

As thousands wait and pray for a kidney, pancreas, liver, heart, or other potentially life-saving organ, physicians can seize this opportunity to contribute to the betterment of Americans' health. (For more information, see http://www.organdonor.gov.)