Families Nix Organ Donations
Facing an increasingly dire shortage of organs, transplant teams have long assumed that organ donation would rise if doctors would just approach more families and broach the subject at the trying time of a relative’s death.
New findings suggest it’s going to be much more complicated.
A large study of potential organ donor cases in Pittsburgh, Pa., and Minneapolis shows that the biggest obstacle to organ procurement is the low rate of consent among families.
“It’s not simply a matter of getting health-care providers to ask the question,” says Laura A. Siminoff, director of research projects at the University of Pittsburgh’s Center for Medical Ethics, who led the study. “That was wishful thinking. A lot of people just say no.”
The study debunks two key assumptions of recent public policy on organ donation: that most families will donate if asked, and that most health-care teams don’t bother to ask.
The Pittsburgh-Minneapolis study found that families were approached about organ donation in 87% of eligible cases. Fewer than half of those--48%--agreed to donate kidneys, livers, hearts or other transplantable organs. A lower percentage of families agreed to donate skin, bones or other bodily tissues (35%) or corneas (23%) for transplantation.
Siminoff’s team reviewed the medical charts of more than 10,000 deaths during a 20-month period at 23 hospitals in the Pittsburgh and Minneapolis-St. Paul metropolitan areas. About one out of six patients was eligible to donate some combination of organs, tissues and corneas. Researchers interviewed the doctors, nurses, social workers and clergy who spoke to families in 827 of those cases.
“Although health-care professionals do request that families donate, families consent to donation less frequently than was previously assumed,” concludes the study, published earlier this month in the Annals of Internal Medicine.
“People are still uneasy about organ donation,” says co-author Arthur L. Caplan, director of the Center for Bioethics at the University of Pennsylvania Medical Center. He was at the University of Minnesota when the study was begun.
Families may reject organ donation for many reasons, says Caplan, who was a leading advocate of Required Request laws. Some say no because of religious beliefs. Some have qualms about harming or mutilating a body. Some question the value of transplanting organs. Some are turned off by what they perceive as an insensitive request by a doctor in their time of grief.
“If it’s family resistance--and I’m now convinced it is--I’m skeptical we’re going to be able to think of anything dramatic to persuade those potential donors to become actual donors,” he says.
The largest source of transplant organs is the estimated 6,000 to 10,000 people who die of brain death in intensive care units each year. Most are otherwise healthy people struck down by highway crashes, shootings or other traumatic injuries.
But even if all of those became organ donors, an acute shortage of organs would persist. Nearly 41,000 Americans are on waiting lists, in need of a kidney, liver, heart or other transplantable organ. Thousands more never reach the official waiting lists.
Opinion polls show widespread public support for organ donation and transplantation in the abstract. But the Pittsburgh-Minneapolis study suggests that many families remain reluctant to consent to organ donation even when approached after a relative’s death.
“Despite what the polls say, we really have quite a ways to go,” Siminoff says.
