Unpredictable Consent Practices by Cadaver Organ Procurement Organizations

[Guest guest]

Unpredictable Consent Practices by Cadaver Organ Procurement Organizations

WESTPORT, CT (Reuters Health) Jan 17 - Organ procurement organizations

(OPOs), charged with cadaveric solid organ procurement within their

catchment areas, engage in divergent, often unpredictable practices for

accepting organ donation consent, according to a report in the January 17th

issue of The Journal of the American Medical Association.

More than 6400 individuals died in 1999 awaiting organ transplants.

Increased numbers of organ donors are required to address this need, the

authors explain, and improved consent procedures may foster cadaver organ

donation.

To understand current procurement policies and to understand the impact of

those policies on procurement, Dr. Dave Wendler and Neal Dickert from the

National Institutes of Health in Bethesda, land surveyed 61 OPOs across

the US.

Living wills, drivers' licenses, and donor cards received essentially equal

weight in the OPOs' determination of an individual's donation wishes, the

report indicates.

When the next of kin's wishes differed from those of the deceased, though,

the wishes of the next of kin were likely to be honored, the report

indicates. Only when the holder of a durable power of attorney who was not a

family member sustained the wishes of the deceased were more than half the

OPOs likely to proceed with organ procurement against the wishes of the next

of kin.

More than 40% of OPOs said they would procure organs from a deceased who had

opposed donation if the next of kin supported the donation, according to the

results.

Overall, an equal proportion of OPOs followed the deceased's and the next of

kin's wishes (31%), the researchers note. The remaining OPOs procured if

neither party objected (21%), if either party consented or neither objected

(13%), or did not follow any of these policies (3%).

Nearly half the OPOs ranked the impact on the deceased's family foremost in

their consent practice, whereas only 12% ranked the deceased's wishes as

most important, the results indicate.

Regardless of their stated procedures, the OPOs' consent practices showed no

clear correlation with them, the investigators observe.

" Contrary to the prevailing wisdom, " the authors conclude, " there is

significant divergence in OPOs' consent practices with regard to cadaveric

solid organ procurement. These data point to the need for an explicit

nationwide debate on the ethics of consent for cadaveric solid organ

procurement, " they assert.

" These findings should be disconcerting to anyone concerned with organ

transplantation, " writes M. Capron, Esq. from the University of

Southern California Law School in Los Angeles. " 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. "

Any process to review existing laws " must ensure full and active involvement

of the public, the medical profession, groups representing patients awaiting

transplants, and representatives of the OPOs, " concludes Capron. The process

" should also include careful evaluation of the policies contributing to the

inconsistent consent practices for organ procurement documented by Wendler

and Dickert. "

No one is responsible for enforcement of the Uniform Anatomical Gift Act

(UAGA), Capron told Reuters Health. " The UAGA gives authority to people to

act on the choices made by the decedent, or if none, by a specified list of

next-of-kin and others, " he explained. " The law doesn't mandate an action by

the OPOs (as a rule from DHHS or UNOS might). So, no enforcement. "

However, " an OPO that took organs on the relatives' 'permission' when the

deceased had refused this would be violating the UAGA in that state, " he

added.

" The problem now is that we proclaim that we want people to express their

wishes and fill out donor cards, yet this study shows that those wishes are

then ignored more often than not, " Capron said. This " is not only

disrespectful of the individuals whose wishes are overridden, but also

seriously contradicts a universally legislated policy and, in the bargain,

undermines efforts to get donors to take the whole thing seriously. "

JAMA 2001;285:329-336.

[Guest guest]

Unpredictable Consent Practices by Cadaver Organ Procurement Organizations

WESTPORT, CT (Reuters Health) Jan 17 - Organ procurement organizations

(OPOs), charged with cadaveric solid organ procurement within their

catchment areas, engage in divergent, often unpredictable practices for

accepting organ donation consent, according to a report in the January 17th

issue of The Journal of the American Medical Association.

More than 6400 individuals died in 1999 awaiting organ transplants.

Increased numbers of organ donors are required to address this need, the

authors explain, and improved consent procedures may foster cadaver organ

donation.

To understand current procurement policies and to understand the impact of

those policies on procurement, Dr. Dave Wendler and Neal Dickert from the

National Institutes of Health in Bethesda, land surveyed 61 OPOs across

the US.

Living wills, drivers' licenses, and donor cards received essentially equal

weight in the OPOs' determination of an individual's donation wishes, the

report indicates.

When the next of kin's wishes differed from those of the deceased, though,

the wishes of the next of kin were likely to be honored, the report

indicates. Only when the holder of a durable power of attorney who was not a

family member sustained the wishes of the deceased were more than half the

OPOs likely to proceed with organ procurement against the wishes of the next

of kin.

More than 40% of OPOs said they would procure organs from a deceased who had

opposed donation if the next of kin supported the donation, according to the

results.

Overall, an equal proportion of OPOs followed the deceased's and the next of

kin's wishes (31%), the researchers note. The remaining OPOs procured if

neither party objected (21%), if either party consented or neither objected

(13%), or did not follow any of these policies (3%).

Nearly half the OPOs ranked the impact on the deceased's family foremost in

their consent practice, whereas only 12% ranked the deceased's wishes as

most important, the results indicate.

Regardless of their stated procedures, the OPOs' consent practices showed no

clear correlation with them, the investigators observe.

" Contrary to the prevailing wisdom, " the authors conclude, " there is

significant divergence in OPOs' consent practices with regard to cadaveric

solid organ procurement. These data point to the need for an explicit

nationwide debate on the ethics of consent for cadaveric solid organ

procurement, " they assert.

" These findings should be disconcerting to anyone concerned with organ

transplantation, " writes M. Capron, Esq. from the University of

Southern California Law School in Los Angeles. " 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. "

Any process to review existing laws " must ensure full and active involvement

of the public, the medical profession, groups representing patients awaiting

transplants, and representatives of the OPOs, " concludes Capron. The process

" should also include careful evaluation of the policies contributing to the

inconsistent consent practices for organ procurement documented by Wendler

and Dickert. "

No one is responsible for enforcement of the Uniform Anatomical Gift Act

(UAGA), Capron told Reuters Health. " The UAGA gives authority to people to

act on the choices made by the decedent, or if none, by a specified list of

next-of-kin and others, " he explained. " The law doesn't mandate an action by

the OPOs (as a rule from DHHS or UNOS might). So, no enforcement. "

However, " an OPO that took organs on the relatives' 'permission' when the

deceased had refused this would be violating the UAGA in that state, " he

added.

" The problem now is that we proclaim that we want people to express their

wishes and fill out donor cards, yet this study shows that those wishes are

then ignored more often than not, " Capron said. This " is not only

disrespectful of the individuals whose wishes are overridden, but also

seriously contradicts a universally legislated policy and, in the bargain,

undermines efforts to get donors to take the whole thing seriously. "

JAMA 2001;285:329-336.

[Guest guest]

Unpredictable Consent Practices by Cadaver Organ Procurement Organizations

WESTPORT, CT (Reuters Health) Jan 17 - Organ procurement organizations

(OPOs), charged with cadaveric solid organ procurement within their

catchment areas, engage in divergent, often unpredictable practices for

accepting organ donation consent, according to a report in the January 17th

issue of The Journal of the American Medical Association.

More than 6400 individuals died in 1999 awaiting organ transplants.

Increased numbers of organ donors are required to address this need, the

authors explain, and improved consent procedures may foster cadaver organ

donation.

To understand current procurement policies and to understand the impact of

those policies on procurement, Dr. Dave Wendler and Neal Dickert from the

National Institutes of Health in Bethesda, land surveyed 61 OPOs across

the US.

Living wills, drivers' licenses, and donor cards received essentially equal

weight in the OPOs' determination of an individual's donation wishes, the

report indicates.

When the next of kin's wishes differed from those of the deceased, though,

the wishes of the next of kin were likely to be honored, the report

indicates. Only when the holder of a durable power of attorney who was not a

family member sustained the wishes of the deceased were more than half the

OPOs likely to proceed with organ procurement against the wishes of the next

of kin.

More than 40% of OPOs said they would procure organs from a deceased who had

opposed donation if the next of kin supported the donation, according to the

results.

Overall, an equal proportion of OPOs followed the deceased's and the next of

kin's wishes (31%), the researchers note. The remaining OPOs procured if

neither party objected (21%), if either party consented or neither objected

(13%), or did not follow any of these policies (3%).

Nearly half the OPOs ranked the impact on the deceased's family foremost in

their consent practice, whereas only 12% ranked the deceased's wishes as

most important, the results indicate.

Regardless of their stated procedures, the OPOs' consent practices showed no

clear correlation with them, the investigators observe.

" Contrary to the prevailing wisdom, " the authors conclude, " there is

significant divergence in OPOs' consent practices with regard to cadaveric

solid organ procurement. These data point to the need for an explicit

nationwide debate on the ethics of consent for cadaveric solid organ

procurement, " they assert.

" These findings should be disconcerting to anyone concerned with organ

transplantation, " writes M. Capron, Esq. from the University of

Southern California Law School in Los Angeles. " 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. "

Any process to review existing laws " must ensure full and active involvement

of the public, the medical profession, groups representing patients awaiting

transplants, and representatives of the OPOs, " concludes Capron. The process

" should also include careful evaluation of the policies contributing to the

inconsistent consent practices for organ procurement documented by Wendler

and Dickert. "

No one is responsible for enforcement of the Uniform Anatomical Gift Act

(UAGA), Capron told Reuters Health. " The UAGA gives authority to people to

act on the choices made by the decedent, or if none, by a specified list of

next-of-kin and others, " he explained. " The law doesn't mandate an action by

the OPOs (as a rule from DHHS or UNOS might). So, no enforcement. "

However, " an OPO that took organs on the relatives' 'permission' when the

deceased had refused this would be violating the UAGA in that state, " he

added.

" The problem now is that we proclaim that we want people to express their

wishes and fill out donor cards, yet this study shows that those wishes are

then ignored more often than not, " Capron said. This " is not only

disrespectful of the individuals whose wishes are overridden, but also

seriously contradicts a universally legislated policy and, in the bargain,

undermines efforts to get donors to take the whole thing seriously. "

JAMA 2001;285:329-336.

[Guest guest]

Unpredictable Consent Practices by Cadaver Organ Procurement Organizations

WESTPORT, CT (Reuters Health) Jan 17 - Organ procurement organizations

(OPOs), charged with cadaveric solid organ procurement within their

catchment areas, engage in divergent, often unpredictable practices for

accepting organ donation consent, according to a report in the January 17th

issue of The Journal of the American Medical Association.

More than 6400 individuals died in 1999 awaiting organ transplants.

Increased numbers of organ donors are required to address this need, the

authors explain, and improved consent procedures may foster cadaver organ

donation.

To understand current procurement policies and to understand the impact of

those policies on procurement, Dr. Dave Wendler and Neal Dickert from the

National Institutes of Health in Bethesda, land surveyed 61 OPOs across

the US.

Living wills, drivers' licenses, and donor cards received essentially equal

weight in the OPOs' determination of an individual's donation wishes, the

report indicates.

When the next of kin's wishes differed from those of the deceased, though,

the wishes of the next of kin were likely to be honored, the report

indicates. Only when the holder of a durable power of attorney who was not a

family member sustained the wishes of the deceased were more than half the

OPOs likely to proceed with organ procurement against the wishes of the next

of kin.

More than 40% of OPOs said they would procure organs from a deceased who had

opposed donation if the next of kin supported the donation, according to the

results.

Overall, an equal proportion of OPOs followed the deceased's and the next of

kin's wishes (31%), the researchers note. The remaining OPOs procured if

neither party objected (21%), if either party consented or neither objected

(13%), or did not follow any of these policies (3%).

Nearly half the OPOs ranked the impact on the deceased's family foremost in

their consent practice, whereas only 12% ranked the deceased's wishes as

most important, the results indicate.

Regardless of their stated procedures, the OPOs' consent practices showed no

clear correlation with them, the investigators observe.

" Contrary to the prevailing wisdom, " the authors conclude, " there is

significant divergence in OPOs' consent practices with regard to cadaveric

solid organ procurement. These data point to the need for an explicit

nationwide debate on the ethics of consent for cadaveric solid organ

procurement, " they assert.

" These findings should be disconcerting to anyone concerned with organ

transplantation, " writes M. Capron, Esq. from the University of

Southern California Law School in Los Angeles. " 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. "

Any process to review existing laws " must ensure full and active involvement

of the public, the medical profession, groups representing patients awaiting

transplants, and representatives of the OPOs, " concludes Capron. The process

" should also include careful evaluation of the policies contributing to the

inconsistent consent practices for organ procurement documented by Wendler

and Dickert. "

No one is responsible for enforcement of the Uniform Anatomical Gift Act

(UAGA), Capron told Reuters Health. " The UAGA gives authority to people to

act on the choices made by the decedent, or if none, by a specified list of

next-of-kin and others, " he explained. " The law doesn't mandate an action by

the OPOs (as a rule from DHHS or UNOS might). So, no enforcement. "

However, " an OPO that took organs on the relatives' 'permission' when the

deceased had refused this would be violating the UAGA in that state, " he

added.

" The problem now is that we proclaim that we want people to express their

wishes and fill out donor cards, yet this study shows that those wishes are

then ignored more often than not, " Capron said. This " is not only

disrespectful of the individuals whose wishes are overridden, but also

seriously contradicts a universally legislated policy and, in the bargain,

undermines efforts to get donors to take the whole thing seriously. "

JAMA 2001;285:329-336.