Donor groups think fast as patients die waiting

August 02, 1994|By Deborah S. Pinkney | Deborah S. Pinkney,Special to The Sun

Every day, about nine Americans awaiting organ transplants die before a donor can be found.

That grim fact is not likely to change soon. While waiting lists have nearly doubled since 1988, the donor pool has grown only slightly.

"Organ donation is one of those things that everyone's in favor of, like motherhood and apple pie, but when it comes to doing something about it, nothing seems to happen," says Dr. Alan R. Hull, vice president of the National Kidney Foundation.

Adds William DeJong, Ph.D., adjunct lecturer at the Harvard School of Public Health: "A number of people in the transplant community have overstated what public education can achieve."

Disappointed by the results of public education efforts, Mr. DeJong and other authorities now say it's time to target a new group -- physicians.

To date, little attention has been paid to the physician's role in the process. Yet it's often a doctor who decides whether to find out if a deceased patient is a candidate for donation and who broaches the subject with grieving family members. How well physicians handle their role -- and how willing they are to defer to procurement experts -- can make all the difference, those experts say.

With improved physician awareness, the number of donor organs could be doubled to about 25,000 a year, says Carol Beasley, managing director of Partnership for Organ Donation, a nonprofit Boston advocacy group. Ms. Beasley's group, in collaboration with the Harvard School of Public Health and several organ banks, examined more than 40,000 medical records from 100 hospitals dating back to 1990. They found that physicians failed to identify about one-third of acceptable donors, Ms. Beasley says.

"If doctors and hospitals did their jobs right, clearly we would have a marked improvement in the current situation," says Dr. Peter R. Holbrook, chairman of the Department of Critical Care Medicine at Children's National Medical Center in Washington. "It would translate, at every step along the way, into more donated organs."

Organ procurement and transplantation experts say physician response often breaks down in one or more of the following areas:

* Assessment of donor suitability: For example, physicians wrongly assume that a patient's advanced age or illness is an automatic disqualifier.

* Reluctance to offend survivors: Doctors worry that families will accuse them of being more concerned with retrieving organs than providing quality care. Yet nine in 10 people surveyed by the Partnership for Organ Donation said they believed physicians did everything they could to save lives before seeking organs for transplant.

* Timing of donation discussion: Physicians often broach the subject at the same time they inform survivors of a loved one's death. Family members don't yet fully comprehend that death has occurred and so are put off by the request.

* Explanation to survivors of brain death: Many people equate this prerequisite for donation with a comatose state and believe recovery is still possible. This is one of the biggest barriers to donation.

* Utilization of organ procurement experts: Hospital staff either fail to contact the experts at all, or approach survivors for consent without aid from specially trained procurement professionals.

Yet a recent study by the partnership (to be published in the near future) found that families consented to donation at a far higher rate when they were approached by physicians and procurement professionals working together than when physicians made the contact alone.

"Much of what keeps the donation rates down is within the power of the hospital staff to change," Mr. DeJong says.

But physicians -- especially primary care doctors -- can make the most difference when patients are healthy, experts say.

"Family physicians have an important role to play here," Mr. DeJong says. "The key is to find different ways to get people thinking about this issue, making a decision and then discussing it with their family."

Donor cards not binding

Incorporating family discussion is essential, Mr. DeJong notes. Donor cards are not legally binding, so hospitals always require family consent. And if family members don't know what the patient would have wanted, they are half as likely to approve, according to "The American Public's Attitudes Toward Organ Donation and Transplantation," a 1993 survey by the Gallup Organization.

"Prior to the crisis, during the normal routine of a physical or some other routine doctor visit, it would be a relatively simple thing for the physician to give patients information about organ donation that they can take home, just as a reminder, to encourage them to talk to their families about the issue and what they would want done," Mr. DeJong says.

"We have to be inventive in finding ways to remind people to talk about it. Simply mentioning it is not enough."

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