Groups studies reasons for donation refusal

What prevents the organs of a deceased individual with a valid organ donor card from being used? That's the question that the United Network for Organ Sharing (UNOS) in Richmond, VA, wanted an answer to when it commissioned the Advance Directives and Donor Card Effectiveness Survey last June.

The purpose of the study was to examine the feasibility and legal ramifications of enforcing the wishes of deceased individuals with valid donor cards or advance directives. Valid donor cards must be signed by the individual and include a witness' signature.

The current practice, according to the survey, is for hospital and organ procurement organizations to place greater emphasis on the next-of-kin's consent - regardless of valid donor documentation. As a result, strategies should be developed that acknowledge the balance between a deceased patient's stated wishes and the considerations of the next-of-kin, according to the survey results.

The survey was sent to all 63 organ procurement organizations across the nation and had a 65% response rate. The survey confirmed an ambivalence among the organ procurement organization community toward the use of advance directives. (For statistics on advance directives and donor card effectiveness, see the chart, inserted in this issue.)

Highlights of the survey include the following:

· 84% of respondents would act on seeking an organ donation only after obtaining family approval;

· 70% did not know whether a potential donor had advance directives;

· 47% to 60% rarely check for advance directives;

· Family wishes, feelings, and involvement - not fear of legal liability - were the top reasons given for not seeking donation.

The survey recommends creating a solution that accommodates both the deceased patients' wishes and the considerations of the family. The survey also recommends the following:

· 100% referral of all hospital deaths to organ procurement organizations. Only 21% of organ procurement organizations have more than half of their hospitals reporting all deaths, according to the survey. The procurement organizations conduct regular audits which should encourage compliance, develop awareness, and build relationships with appropriate hospital personnel, such as trauma and neurology staff.

· 24-hour access to an organ donor registry or database of donative intent. The keys to a useful registry, the survey points out, are comprehensiveness, access by the appropriate emergency, hospital, and organ procurement organization personnel. The registry also should be confidential and allow a person to easily change his or her intent, the survey adds. Expanded opportunities to register should be included at state services offices for non-drivers. Other expanded opportunities include voting and Social Security offices. Searches for donative documents at accident scenes or hospitals are rarely performed, the survey notes.

· Policy of informing families of decedent wishes rather than asking for consent. This recommendation would work in tandem with the previous recommendation. Although respondents noted instances where a decedent's wishes were overruled by a family member, most families are relieved to know of their loved one's intentions. Implementing the recommendation within a legal framework would require repealing provisions of the Omnibus Reconciliation Act of 1986, the survey adds.