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"measures necessary to ensure the medical suitability of an organ for transplantation or therapy may not be withheld or withdrawn from the prospective donor."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]

Organ Transplants - a 50 Year Look Back

From the New York Times.

NPR Story on matchingdonors.com

Mark Fox, chair of UNOS' ethics committee, is featured in this excellent All Things Considered piece.

Ads to Get a Liver Condemned by UNOS

Houston Chronicle and Richmond Times Dispatch report on the UNOS decision to recommend that transplant programs refuse to transplant organs where solicitation for those organs has been performed. The recommendation is just that, and there was no modification of official policy of UNOS, so hospitals are free to ignore UNOS on this matter. The Houston hospital where the pivotal case under discussion occurred has already planned to review its policies:

Todd Krampitz garnered national attention last summer when he advertised for a new liver on two Houston billboards and a Web site. Doctors had diagnosed the 32-year-old Houston man's severe liver cancer in May, and he was deemed too sick to be placed on donor lists. A week after going public, Krampitz received an organ from an out-of-state family who had heard of his plight. The operation was performed at The Methodist Hospital.

Sherril Lanthier, director of the Multiorgan Transplant Center at The Methodist Hospital, said the hospital will review the new recommendation announced late Friday. "We look at everything that comes from UNOS and we follow their guidelines," Lanthier said. "We will look at it ourselves and make a policy within the hospital." But she added: "We can't control what our patients do. We certainly don't advocate it."

After Krampitz's surgery, he and his wife, Julie, put up another billboard saying "Thank You," and encouraged more people to consider organ donation. After their successful appeal, others in need of organs used similar campaigns.

The nearly unanimous vote Thursday by UNOS officially condemned soliciting organ donations through advertising.

Dying to Live

Major new series on organ tranplant issues. Not to be missed. - Art Caplan

Mark Yarborough of UCHSDenver on Record on Web Transplant

Well, we've blogged the heck out of the stupidest Internet health story of the year, the matchingdonors.com kidney transplant that was almost stopped by the hospital ethics committee, then was allowed, then stopped because of PR. Denver's bioethics director and transplant ethics scholar Mark Yarborough hits the issue on CBS.com, although we are still waiting for the story about how this happened in the first place. And how many people are sitting around waiting for a MatchingDonors.com "date." We do know now (from this piece) that MatchingDonors.com puts all its money into the "maintenance of the web site," which is a bit like a car dealership saying that all of the money it brings in goes to maintaining the car dealership...

organs.eBay.com (UPDATED AGAIN)

St. Luke's (Denver) ethics committee tried to stop the transplant of a kidney from one man, who paid $290 to post his profile on the Internet at a new website called MatchingDonors.com, to another. In a "compassionate exception" the hospital decided that this was an appropriate thing to do just this once, before they debate things. Precedent doesn't seem to be an issue for them. And the CEO of the hospital took great pains to say that it is not endorsing the website. Mr. Smitty, the donor, was to be paid $5,000 for his kidney ... I mean ... for his travel expenses. UPDATE: After innumerable stories reported on the phenomenon, hospital officials decided to cancel the transplant. Interestingly, George Annas uses the case as a (brilliant) opportunity to demonstrate that we would not have problems like this if organ procurement were both a higher priority and better executed. UPDATE2: Rocky Mountain News' piece is just out and interesting. Art Caplan is interviewed on it at Medscape. UPDATE3: A shakedown for life? UPDATE4: USA Today begins the spinning of the implications of the matchingdonors saga.

A Tax Break for Organ Donors?

From Christian Science Monitor.