Christian Sinclair, a palliative care and hospice physician who writes on the Pallimed blog, caught the NPR story on the Organ Procurement and Transplantation Network/United Network for Organ Sharing (OPTN/UNOS) meeting earlier this week to issue new sweeping rules on “Donation after Cardiac Death.”
Good news, for now, BTW. We have been informed that the new guidelines have been tabled.
Sinclair was especially alarmed by statements made by Dr. Stuart Youngner in the audio version of the NPR story that – quite frankly – we missed. Excerpt from Proposed Changes to Organ Donation Blur the Line on End of Life Care:
Rolling into work this morning, NPR reported on a radical change in organ donation policies which could profoundly change how palliative care is perceived and how families and health care professionals make those very challenging decisions at the end of life. At the heart of the effort is an attempt to increase the number of organ donors of course but the ethical question is in how to achieve that noble goal. Among the changes under consideration is the ability for hospitals and organ procurement organizations (OPOs) to make their own policies on how to approach families and patients about organ donation instead of following national guidelines.
I’ve have worked with OPOs in the hospital setting and have had overall some very good professional and ethical experiences. But allowing too much individual variation could lead to abuses of the system which would negatively impact patients and families. Why wouldn’t their be best practices from which all the sites could rely on? To go from national standards to individual policies that could be unduly influenced seems to be a regression of ethics.
There must always be a clear line between the clinical team treating the patient and the team with the skills and ability to harvest organs from a deceased patient. That has been a long held standard of transplant ethics and is reinforced in the story by a bio-ethicist, Dr. Stuart Youngner. In the audio version of the story (not the print version) Dr. Youngner also mention that in one hospital he works with the organ transplant team tries “to be introduced to families early, not as organ procurement organizations but as end-of-life care specialists.“
(I’d point out that if Dr. Sinclair followed the NDY blog or followed us on twitter, he’d have known about this a lot sooner. The fact is, groups and individuals alarmed about these proposed changes are responsible for getting NPR’s attention. Transplant advocates don’t seem to want a public discussion and haven’t been reaching out to the press to publicize the proposed changes.)
Good news that this “change” in organ procurement rules has been tabled for now and, hopefully, forever.
I don’t think it would be possible to protect the potential organ donors from inappropriate influences when the goal is to increase the availability of organs for transplant.
While the goal itself may be admirable, the risk of abuse of the donors is too great and it would be almost impossible to monitor abuse when hospitals themselves could develop their own protocols.
Just as patients are “product” for profit in our health care system, organs are “product” for profit and “let the donor beware!”
What if there was no legal way to be informed of charts as family about this by the doctor, as in Canada? It can be done and told after…
Indeed, it is just as when I stood with you all on the steps of the Supreme Court during the Quill v. Glucksburg case whereby some were trying to force the decriminalization of physician-assisted suicide. Several friends in wheelchairs held signs with concentric circles on them across the middle of which was the statement “We ARE the target”! Citizens beware and draw up legally protecting documents now while refusing to sign living wills or DNR’s – we must be proactive about protecting ourselves in an era in which our lives have been so devalued by society.