Parents Push Measure to Remove Barriers to Organ Donations

Ron and Patti Ranus, grief-stricken, looked at their 11-year-old daughter lying before them in the desert hospital, no hope for bringing her back from a brutal head injury caused by a dune buggy accident.

Then, through the tears, they looked at each other. “Honey,” Ron Ranus recalls saying, “I know it’s too late for Cassie, but maybe we can keep someone else from going through this pain.”

He asked if she agreed with him that an organ donation would be the right thing to do. “Cassie would like that,” said her mother.

The transplant never happened. But the experience gave Ron Ranus a new mission in life.

A deputy Imperial County coroner refused the couple’s request to allow a transplant team to examine Cassie’s body for organs or tissue that might be used to save another life.

Ranus, 54, a pharmaceutical firm representative who has medical training, said the reasons he was given at a Brawley hospital in April 1995 made no sense. At that point, he decided not to argue about the refusal.

But in the aftermath of the family’s loss and failure to salvage from it something positive, Ron Ranus became the prime mover in a legislative effort to clear the barriers to organ transplants in cases handled by the coroner. Ranus argued that coroners too often withhold permission to harvest organs because they believe--wrongly, he says--that the procedure would interfere with accident or criminal investigations.

He turned for help to Assemblyman Brett Granlund (R-Yucaipa), who fashioned a bill addressing the problem. It passed 65 to 0 in the Assembly last month--avoiding the partisan wars that erupted over such lesser questions as disciplining curfew violators--and is now before the state Senate.

Granlund’s measure (AB 3145) would require organ procurement organizations to adopt strict rules to determine how organs can be removed for transplant without disturbing other body parts possibly needed as forensic evidence in accident or criminal cases. It would require coroners to explain instances where permission was denied. The bill would only encourage, not force, coroners to enter into such “protocols” in the first place.

The measure is one of three before the Legislature governing organ retrieval practices, including AB 2861 by Assemblyman Antonio Villaraigosa (D-Los Angeles). Passed without opposition last month, the bill would not allow providers to deny transplant requests from disabled people. The measure was inspired by Sandra Jensen, a heart-lung transplant recipient with Down syndrome who was turned down by two hospitals before one agreed to the procedure.

Opponents of the Granlund bill have charged that it is driven by the “anomaly” of the Ranus case, and that agreements are in place allowing organ retrieval in a high proportion of coroner cases. At best, they argue, the bill is not necessary.

In Los Angeles County, Craig Harvey, chief of coroner’s investigations, said of the Granlund measure: “We’re already doing 99% of [the bill’s requirements] anyway.” With staff on hand to make informed decisions, he said, rarely does the coroner’s office deny a request for organ retrieval from among the county’s 19,000 coroner cases a year.

Bob Bowers, president the California State Coroners Assn., said injecting legislation into the process would only undermine “relations based on trust” among coroners, medical examiners, forensic experts and transplant recovery teams.

“If they tell us to do a protocol,” Bowers said, “it won’t be long before they tell us how to do a protocol.”

Often, Bowers said, only trained pathologists can tell if disturbing an organ would compromise an investigation, particularly in dealing with bodies of “6- and 7-year-olds who have been victims of child abuse.”

Bowers said that in Sacramento County, where he is an assistant coroner, only 13% of requests for organ retrieval in coroner cases are denied. “If it’s a drive-by, a gunshot to the head, we’ll allow a transplant on that victim. We know it isn’t going to affect our investigation.”

The coroners association likes the goodwill associated with making transplants happen, he said. His group “likes all the positives we can get, and transplantation is one of them.”

But Ranus, who represents his company’s products to doctors at Loma Linda University Medical Center and who has set up an organ donor organization in his daughter’s name, says the bill is necessary if only because of the nation’s urgent need for transplant organs.

“As of March 31st this year, we had 45,308 nationwide on waiting lists for hard organs--hearts, lungs, livers, kidneys, pancreases,” Ranus said. “The number grows by 1,000 a month.” Up to 30% will die, he said, because no matching organs were available.

Ranus’ employer, Hoffmann-La Roche, a U.S. subsidiary of a Swiss pharmaceutical company, is the maker of an anti-rejection drug used in transplant procedures. A Sacramento lobbyist for the firm is promoting passage of the Granlund bill. But Ranus said--and the Loma Linda hospital confirmed--that Ranus makes no attempt to sell or promote that drug.

Supporters of the Granlund measure cite San Bernardino County as the model for transplant-coroner cooperation that they seek to take statewide.

County Coroner Brian McCormick said a step-by-step protocol was developed for San Bernardino in 1991 governing organ donation and retrieval.

If a person is brain-dead and it becomes a coroner case--as all accidental or crime-related deaths are--a county forensic pathologist evaluates the case to make sure an organ retrieval is possible without compromising evidence in a criminal case, then gives the OK. Denials are recorded in writing, as required by Granlund’s bill. Before 1991, with deputy coroners usually having sole jurisdiction, organ requests were frequently turned down.

Dr. Frank Sheridan, the county’s chief medical examiner, said since the protocol was adopted, the denial rate has been “virtually zero. I think I turned down one in the last 18 months.”

McCormick, a backer of Granlund’s bill, said “counties like L.A. are doing a tremendous job, but there are others that need to get up to speed.” He declined to name them.

Others supporting the bill noted that in 41 of California’s 58 counties, the sheriffs whose first duty is evidence collection double as county coroners.

Until recently, one such county was Imperial County, where the Ranuses lost Cassie. Chief Deputy Coroner Sheriff’s Sgt. Jesse Altamirano said that until recently his department would not allow transplant teams access to bodies, which are kept in cold storage until they can be shipped to San Diego for autopsies.

But “now we allow it,” he said, adding that the county changed its policy about the time of Cassie Ranus death.

He also disclosed an ironic twist that might have changed the course of Ron Ranus’ mission.

Upon checking records, Altamirano said last week, “it looks like there could have been an organ transplant in this case. I don’t know where my deputy was” in refusing the Ranuses’ request. “Out in left field somewhere.”