A better understanding of the consent process that organ procurement organizations (OPOs) use to gain donor organs could lead to the availability of more organs, according to a recent study.
On January 17 in JAMA, Dave Wendler, PhD, and Neal Dickert, BA, found that OPOs use diverse ways to procure organs, and they call for "a national discussion" on whose wishes should be followed when it is time to decide whether a person's organs should be harvested for donation (2001;285:329-333).
Using telephone surveys of the 61 active OPOs in the United States, the authors found that 31% of OPOs follow the wishes of the deceased when deciding whether to procure organs, another 31% follow the next of kin's wishes, 21% procure organs if neither party objects, 13% do so if either party consents or neither objects, and 3% do not follow any of these practices. "These differences appear to be traceable to implicit ethical disagreements about whose wishes should be followed," the authors said.
When the OPOs were questioned on what factor has the most influence on their choice of consent practice, almost half said that impact on the family of the deceased is the most important factor, 21% cited state law, and 11% cited priority for the wishes of the deceased.
The existence of a durable power of attorney also influenced organ procurement. In situations in which a durable power of attorney existed and the deceased supported organ donation but the next of kin opposed it, 56% of OPOs reported they were likely to procure organs. However, in similar situations, only 11% procured organs if documentation existed only in the form of papers such as a living will, donor card, or driver's license.
In an accompanying editorial, Alexander M. Capron, LLB, of University of Southern California Law School wrote: "These findings should be disconcerting to anyone concerned with organ transplantation. The data suggest that OPOs do not follow the law, that their procurement practices vary one from another in unpredictable ways, and that the justifications given by the respondents for their practices bear little relationship to those practices" (2001:285:334-336).
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