New Law to Encourage Organ Donations : Hospitals Must Discuss Option With Families of Dying Patients

A California law took effect Wednesday that requires hospitals to develop procedures so that medical personnel will ask families of dying patients about organ donations.

The law calls for such discussions to be conducted with “reasonable discretion and sensitivity,” including regard for religious beliefs.

The new law seeks to increase the supply of cadaver organs for transplants while preserving the voluntary nature of organ donations.

It is designed to avoid the not-uncommon situation in which some patients die while awaiting a donor organ--and while the families of some potential organ donors are never informed or reminded of the possibility of donations.

Experts Divided

Some hospitals already have such procedures. Those that do not are expected to develop them gradually. The new law does not specify sanctions against hospitals that do not develop such programs.

Experts are divided on whether “required request” laws will increase the availability of organs.

“In many ways, this is an experiment,” said attorney Leslie S. Rothenberg of the UCLA Medical Center. “Logically it makes a lot of sense, but I’m not convinced it will make a difference,” he said. “I would be happy to be proven wrong.”

Another method to increase the supply of organs that has been tried in California is the use of donor cards, on which individuals can indicate their willingness to make donations. These wallet-sized cards are mailed with driver’s licenses.

Cards Don’t Work

Most experts say, however, that such cards have done little to increase the organ supply because many people do not carry them and physicians and hospital officials are reluctant to rely on the legal authority of the cards, even when they are signed.

At the end of 1984, about 10,000 to 12,000 people nationwide were waiting for kidney transplants, 3,500 were waiting for cornea transplants, 100 for heart transplants, 50 for heart-lung transplants and 300 for liver transplants, according to Arthur L. Caplan of the Hastings Center in Hastings-on-Hudson, N.Y, an expert in organ donation.

Caplan said that a “required request” policy has worked well at the few hospitals that have tried it. “When families are asked, the consent rate for organ donation is between 70 and 80%,” he said in a telephone interview.

The California Hospital Assn. sent a memo Dec. 19 to hospitals throughout the state providing guidelines on contacting families about organ donations.

According to the guidelines, the patient’s family should be approached concerning the possibility of organ donation at or near the time of the patient’s death. If the family gives approval, the hospital will then notify an organ procurement agency and assist in the organ donation process.

“There has been a reluctance (among doctors and nurses) to ask families of deceased patients about this,” said Allen Toon, a spokeman for the California Hospital Assn. “The organ procurement agencies believe that this law will improve the availability of needed organs.”

New York and Oregon already have so-called “required request” laws for organ donation, and many other states, such as Massachusetts, Michigan and Pennsylvania, have such a requirement under consideration in their state legislatures.