A groundbreaking Pennsylvania law credited with increasing organ donations and transplants by more than 30 percent is moving a group of Maryland lawmakers to write a similar bill.
Under the plan, acute care hospitals would be required to report all deaths to the Transplant Resource Center of Maryland Inc., whose staff would assess donor potential. Another provision would allow only specially trained people to contact the next of kin for donations.
"It makes a significant difference because the trained clinical coordinator typically does a better job of explaining the option of donor or tissue donation, so typically the consent rate is much higher," said Joseph J. O'Donnell Jr. of the transplant center.
Maryland has seen a meteoric rise in the number of people awaiting transplants since 1992. That year, 282 people were on the waiting list. But technological advances and an increase in area transplant surgeons have raised the number of potential transplant candidates to nearly 2,000 as of Nov. 3, 1997.
Yet, on average, only 66 people each year have donated organs in Maryland since 1992.
"The provisions Pennsylvania has put in place have made a significant difference -- it's what we need to do here in Maryland," said Del. Peter A. Hammen, a Baltimore Democrat who is co-chairman of a legislative task force on the issue. "I think it's very exciting knowing the lives this will impact."
Other features call for protocols at hospitals to encourage early referrals, periodic reviews of hospital death records, fines for hospital noncompliance and more public education.
Little opposition expected
Hammen expects the bill to move smoothly to approval when the General Assembly convenes in January.
"I don't see much opposition at all once the bill is heard," he said. "I believe if there were to be obstacles, we would have been aware of them by now."
Hospitals are assessing the proposals, said Nancy Fiedler, spokeswoman for the Maryland Hospital Association.
"We certainly support this conceptually," Fiedler said. "Practically, we're asking, 'Does this enhance the process, or would it create additional barriers or difficulties?'
"We want to look very carefully, for instance, at who is doing the asking: Do they have training, do they have a relationship with the family? In some cases, would a physician be the most appropriate person to ask?"
The idea has been under review since early this year, when a proposal introduced by Sen. William H. Amoss, a Harford County Democrat now deceased, was tabled for further study by the General Assembly. An advisory group consisting of transplant coordinators, hospital officials, doctors and nurses has worked during the past three months to model a recommendation based on Pennsylvania's law. A draft is expected to be finished within two weeks.
"We will get legislation passed, and right now any increase in organ donation is welcome," said Sen. Paula C. Hollinger, a Baltimore County Democrat who is on the task force. "Two thousand people on a waiting list is a lot of people."
Success in Pa.
Howard Nathan, a force behind passage of the Pennsylvania law and executive director of the Delaware Valley Transplant Program in Philadelphia, said calls to his agency went from 250 a month to more than 4,000 a month after the law passed in 1994. Since then, the number of organs recovered annually has gone from 692 to 935, and the number of transplants from 616 to nearly 1,000 in the program's region, which includes the eastern half of Pennsylvania, Delaware and southern New Jersey.
In recent months, motivated by Pennsylvania's success, six other states have enacted similar laws.
Mandatory referrals to the local transplant program have been instrumental in the growing number of organ donations, Nathan said.
"It gets hospital personnel used to the fact that when a person dies, the first thing they think about is donation," he said. "It puts in the front of everybody's mind that donation and death are connected. Five or 10 years from now, families will not be taken aback when asked about it."
Once the law went onto the books in Pennsylvania, Nathan's group began a focused campaign to convince hospitals and staffs of its value.
They met with physicians and nurses, attended medical staff meetings and grand rounds.
"I don't want people to have the impression that if they pass a law everything changes," Nathan said. "It took a lot of work."
Initially the proposal met with resistance from some staff, particularly doctors, who felt that asking the family was their responsibility. Often they ruled out potential donors, assuming they weren't suitable or because they didn't want to interrupt the family's grieving, Nathan said.
"What we found was that many families weren't being offered the option," he said. "Once physicians got used to the idea and worked side by side with us and began to trust us, they accepted it. Now many are saying, 'I'm glad somebody else is doing it.' "