Kill Him Quick, His Organs Are Souring

Police in Southern California and the state Medical Board are investigating whether a transplant surgeon prescribed drugs to hasten the death of a 26-year-old patient in order to harvest his organs more quickly to ensure they would be transplantable. What the doctor is alleged to have done is wrong and, if proven, merits strict punishment.

The public needs to be able to trust doctors to make dying as painless and dignified as possible. And to trust that they'll follow patients' wishes about medical care at the end of their lives. That is why a proposed change in state laws governing organ donation is not a good idea.

Many Americans, while supporting organ donation, have doubts about whether they will receive appropriate care if they identify themselves as organ donors. The frightening story from San Luis Obispo was being joked about on a sports radio station in Philadelphia just the other day. The message: Don't sign an organ donor card or check your driver's license to be a donor because doctors may kill you to get your parts!

We agree with the 85 percent of Americans who respond in polls that organ donation after death is a good thing. Donation helps provide some redemptive value to death, makes grieving less burdensome for family members and, of course, saves lives. But causing death to maximize organ donation is violating all ethical standards governing organ procurement. Fear of this may cause people to revoke or not provide
consent, and that jeopardizes thousands of lives.

Recently, a private but influential legal group, the National Conference of Commissioners on State Laws, revised the Uniform Anatomical Gift Act (UAGA), which is the model that many states have followed to legislate organ donation. The commissioners know there are too few organs available for those in need. Their proposal, which is under consideration by states, is that organ donation consent (on a driver's license, for instance) be allowed to override a person's living will, advance directive or even physician orders. The proposed language in the revision states, "measures necessary to ensure the medical suitability of an organ for transplantation or therapy may not be withheld or withdrawn from the prospective donor." What this means is that if you say you are willing to donate your organs, your advance directive, living will and physician's orders are in trouble.

The revised UAGA, which is under review by the California Department of Health Services and the state Legislature, in one fell swoop nullifies the advance directive of people who have consented to organ donation. If California and other states adopt the revised UAGA as written, advance directives will have to make clear whether the person gives more importance to organ donation or to directions about their end of life care. That is too much to ask.

People have clear opinions on their end-of-life care, including preferences for advanced life support and palliative medications, but also, organ donation. When making organ donation consent at a motor vehicles licensing office in San Jose, Los Gatos or Hollister, people are not asked whether the organ donation should nullify their living will. To assume otherwise makes no sense.

The commissioners may further revise their published recommendations to acknowledge their position that quality end-of-life care is as important as organ donation. They are thinking of adding language that organ-procurement professionals work with critical care physicians and families to try to find a course that promotes both excellent care as patients die and the opportunity to donate organs.

That collaboration is important, but it is essential that the line between caring for the dying and obtaining organs for those in need remain sharp and bright. One of the biggest barriers to obtaining consent for organ donation in California and around the nation is the fear that the consent will lead doctors to make end-of-life decisions based on what is best for organs rather than patients. That is what is troubling about the death in Southern California of Reuben Navarro. That fear should never become the law in California or any other state.
-Art Caplan [from San Jose Mercury News]

posted Mar 20, 2007 | link | jump to the comments (11)

tags: organ transplants

comments

Although it looks like Navarro's death was ruled natural, I'm glad to hear that the appropriate folk are still looking in to misconduct and other charges against the two transplant doctors. The series of actions those two took, at least as have been reported, basically undermine organ procurement while simultaneously underscoring every organ harvest/kill 'em for their internal bits nightmare that exists.

- by Kelly on Mar 20, 2007 at 9:03 AM | link

Good catch and excellent analysis of the problems with the new UAGA.
What really disturbs *me*, though, is this: According to the NCCUSL website, the UAGA has been endorsed by the AMA, United Network for Organ Sharing, the National Kidney Foundation, the Eye Bank Association of America, the American Association of Tissue Banks, the American Academy of Ophthalmology, the Cornea Society, and the Association of Organ Procurement Organizations.
Where were *their* analysts? Did they bother to read this act?
Or - and I don't know which is worse - did they endorse it knowing full well what it contained and what it meant?

- by Stephen Drake on Mar 21, 2007 at 6:36 PM | link

These doctors should be punished. They could have jeopardized the entire organ donation system. It is not the best system and does need improvements. However, by increasing the fear of the public they will only be decreasing the number of people who will donate their organs. Is it not better to educate people about organ donations?
A check mark at the DMV should not override a living will. People dont take the time to really consider organ donation after waiting forever in a line to get your license. A living will is usually thought about more thoroughly. Besides would you want to discuss your choices of organ donation to the guy taking your picture? A family member or doctor is who most of us would be more comfortable discussing our decisions about organ donation.

- by maberg on Mar 22, 2007 at 2:19 AM | link

I, too, agree that if a Doctor had done this it should be punished. In the small hospital that I work in we do not harvest organs only bone,skin and eye type donations, so I really do not deal with this. I can see in a way why they would say that if you were an organ donor that may override your living will because if they are going to harvest organs they need alive oxygen rich organs. If your body is no longer able to sustain life on its own and you are an organ donor don't you think that you are automatically giving premission to be placed on life support for the sole purpose of keeping those organs alive?! I would say so. I do not want placed on life support per my living will to sustain life in event of irreversible death but I personally wouldn't mind if they placed me on long enough to harvest whatever organs they could salvage. I am a organ donor to give my organs. Kinda makes sense doesn't it?

- by H Stetz on Mar 23, 2007 at 2:39 PM | link

I also think that the doctors responsible should be punished in this instance. There are enough people that die awaiting an organ transplant as it is, let alone if the public is scared about donating organs because they think that their doctor is going to kill them quicker to do so. I too have the organ donation marked on my driver's license and can honestly say that I never imagined it would override any legal document that I would eventually put into effect, such as a living will. When at the DMV, I can't say as though there was an indepth conversation about organ donation, only some stranger asking me if I wanted to be an organ donor. Heidi, what you are saying does make sense. If the doctors knew that there was no chance I would be brought back, I wouldn't mind being on a ventilator long enough for them to harvest my organs either. As you said, I'm an organ donor to donate my organs, they aren't going to do me any good in the grave.

- by Jennifer Greeley on Mar 23, 2007 at 3:20 PM | link

I spent 5 years working in a liver, kidney, pancreas transplant unit and worked daily with pre and post transplant patients. I've had many indepth conversations with patients regarding what the wait was like and how much appreciated the organs are...what people who donate do for these peoples' lives is astounding and they should realize that. It's like suddenly you went from being on death row to being given a beautiful, second chance. What a gift!!
I, too, think these doctors need punished although two or three sentences doesn't tell the whole story, I'm sure there's more to it. At the end of the day, we all, those of us who choose to, sign to be organ donors so that our organs are viable enough to save the life of others. If we aren't kept alive on life support, organs can't sit in a corpse for days waiting...even hours for some organs. I'd personally have to agree with the ladies above...put me on life support until the recipient of my organs is on the table waiting and keep my organs fresh enough to save their life.
Dana

- by Dana on Mar 23, 2007 at 6:31 PM | link

The revised UAGA guidelines appear to be a misguided (if well-intentioned) overreach. OPO's and physicians already walk that fine line separating the needs & interests of the dying individual (& her family, friends) and the approximately 100,000 people needing transplants. To insert this legal "end around" which effectively trumps both the patient's more explicit and situation-specific wishes and the physician's treatment plan serves neither group and strectches the concept of advance planning past the breaking point.
On the whole, Donation-after-Cardiac-Death (DCD) guidelines appear to privilege patient wishes & palliative care standards over organ viability if/when the two collide. Perhaps an increasing number of cases will provide more explicit instructions on how better to navigate this terrain in the future.
I personally agree with the last two posters; I too would be willing to allow my dying process to be extended if I knew it would increase the chances that my organs could be better preserved for their recipients. I don't think that most donors/potential donors would object to receiveing blood thinners or staying on a ventilator for an extra hour or so. However, there should be transparancy & education on these items prior to consent.
For what its worth...I think that many OPO's could increase the number of donated organs by consistently and exclusively honoring the clearly stated wishes of the individual or that individual's legal representative. On too many ocassions, I hear of OPO's that decline to havest organs if any family member objects for any reason. This liability-averse practice effectively negates the wishes of the patient and boasts no compelling 'best interests' rationale.

- by R Huff on Mar 23, 2007 at 7:00 PM | link

I have heard many people comment on this topic. They think they will not receive the best treatment if they are an organ donor. I however never heard of a case where they did not get proper treatment until this article. Patients need to have information explained to them regarding advanced directives and organ donor. Families easily get confused and need a thorough explanation so there are no surprises. I think the bottom line should be to only do what the patient wants done, but when discussing with them the option to donate organs, be sure they are clear and understand all the information.

- by Vanessa Nolf on Mar 25, 2007 at 9:28 PM | link

I was 16 when I decided on my own to donate my organs. I even then knew it was a good thing to decide. It is 38 years later and I would decide the same way. Donation is a gift and I would want someone to benefit from my liver etc if in a tragic accident . I would not have my family worry that my care was directed toward the harvest of my organs, in this situation keep me alive for my organs please. If I am dying slow or have a routine situation turn bad most nurses and doctors make decisions based on the patient. Unfortunately more thought should go toward doanation but don't. Give caregivers the benefit of the doubt...don't let a few bad doctors change the thought of donation of organs. Youwon't miss them!

- by Diane c RN on Mar 26, 2007 at 12:24 AM | link

These doctors should be punished. I hate to say it but that is why I have not decided if I want to be an organ donor. I want to be sure that everything is done to save my life. If I don't make it I would love for my misfortune to save another's life. I don't think that signing up for organ donation should void a living will. Those are the wishes of that individual, and should be adhered to.

- by MaryBeth Logan on Mar 26, 2007 at 12:48 AM | link

Of course, like everyone else, I think the doctor should be punished if its proven that he hastened the patients death in order to get his organs. Granted maybe the recipients might have been in a dare need of the organs, it still isn't ethical and could end in a slippery slope. On the subject about our drivers license overriding our living will or our physicians order, thats ridiculous. Like someone mentioned, most of us, if not all, dont talk to the people at the DMV about all the implications of their decision. Some people might just agree because they are in public and want to conform to everyone. How can a simple check-mark on your license, which only takes a few seconds, override a decision you probably spent months making with your family and physician? Im not sure if people under 18 are allowed to put organ donor on their license without their parents consent. But if so that would even be more horrendous. Though it may be time consuming, I think DMV should provide a little more education or information about organ donation than just a simple yes or no question

- by Althea M. on Mar 27, 2007 at 1:51 PM | link