Misconceptions hamper organ donations

Education can dispel potential donors’ myths

Every day, an average of 16 people die waiting for an organ transplant, according to the United Network for Organ Sharing (UNOS) in Richmond, VA. Yet, education could whittle down the waiting list of 70,000 and help save lives.

Unfortunately, misconceptions abound regarding organ donation. Many people believe that the pool for organ donors is large, yet the waiting list is much larger compared to willing donors, says Bob Spieldenner, a spokesman for UNOS.

Each year, about 20,000 people are declared brain dead at medical facilities due to cerebral stroke, a blunt trauma to the head in an accident, or a gunshot wound. From that pool of potential donors, many have a negative medical history, such as being HIV-positive, and are not potential candidates. Of those candidates, only about 5,000 become donors.

The public holds many misconceptions that also help keep the number low. A well-targeted education program, however, could dispel some of the misunderstandings, which include:

• Signing a donor card is all that is needed.

In all states except Pennsylvania, next of kin must consent to the organ donation, regardless of whether or not the victim signed a donor card or stated his or her wishes on a driver’s license. "Many think that just putting their willingness to be a donor on their driver’s license is enough, but it is not. They must have a family discussion around it so there is no doubt," says Spieldenner.

People need to think about organ donation when they are healthy and active, because the ideal candidate is a young healthy individual who has sustained a life-threatening injury, says June Hinkle, RN, MSN, CNP, program manager for bereavement services at The Ohio State University Medical Center in Columbus. Family members are approached at a very difficult time; if there has been no discussion on the matter, the decision is very difficult.

• Brain death isn’t the same as legal death.

The concept of brain death often is introduced to family members at the time they are approached about possible organ donation. "Often, they have never heard that a person can be declared brain dead, and they think they have to make the decision to stop the ventilator. They don’t understand that it is a legal death," says Hinkle. People need to have an understanding of brain death well in advance of a tragedy.

Although the criteria are different in each state, in order for a person to be declared brain dead, he or she can have no reflexes such as blinking, coughing, and gagging; nor can the patient be able to breathe without a ventilator. Once the oxygen is removed, the heart will stop beating because the brain stem is not working, depriving the body of a neurological stimulus to breathe, explains Hinkle. Even with a ventilator, it doesn’t take long after brain death for the heart to quit beating.

• Potential donors will not receive the same life-saving measures as others.

Many people fear that if they declare themselves a potential donor on their driver’s license or a donor card, health care workers will not do everything possible to save their life. People need to understand that such an assumption is false, says Spieldenner. Emergency workers always do whatever they can to save someone, and it is only after someone is declared brain dead that organ donation is considered and the family is approached and permission is requested.

• Celebrities and rich people receive preferential transplant status.

The waiting list is totally blind to wealth, celebrity status, race, and religion. A transplant recipient is basically a number on a list, and the sickest people get the higher priority, says Spieldenner. The organ donor must have a compatible blood type with the recipient, and with kidney transplants, there must be a degree of genetic match.

Health fairs are a good venue for organ donation education, as are health classes within high schools, says Hinkle. High school health classes are an especially good place to begin discussing and why a person might want to become an organ donor, because victims in this age group are often good candidates for organ donation if they should happen to be declared brain dead.

Discussing the concept of brain death is always important. "Students can be taught how people are declared dead and learn that it is not just when the heart quits beating but when the brain quits working," says Hinkle. The organ procurement organization in the region where the medical center is located is a good resource for educational materials. (For more information on where to find educational materials, see Editor’s note at the end of this article.)

Although tissue donation takes a back seat to organ donation because it is a life-enhancing procedure rather than a life-saving procedure, people should receive education surrounding it as well, says Hinkle. Skin can be used for burn victims. Cancer patients often have diseased bones removed and a bone graft rather than a full amputation. "You can actually procure tissue up to 12 hours after someone dies, so you have a little more time to discuss tissue donation," says Hinkle.

[Editor’s note: The Coalition on Donation provides educational materials on organ donation, including a brochure titled "Donate Life for 13 Cents," which explains the need to discuss the decision to become an organ donor with family members. Posters dispelling many of the myths surrounding organ donation are also available for 50 cents each. For more information or to order, contact: Coalition on Donation, 1100 Boulders Parkway, Suite 700, Richmond, VA 23225. Telephone: (804) 327-1447. Fax: (804) 323-7343. Web site: www.shareyourlife.org.] n

For more information on organ donation, contact:

June Hinkle, RN, MSN, CNP, Program Manager for Bereavement Services, The Ohio State University Medical Center, 168 Doan Hall, 410 West 10th Ave., Columbus, OH 43210. Telephone: (614) 293-8505. Fax: (614) 293-6200. E-mail: hinkle-2@medctr.osu.edu.

Bob Spieldenner, United Network for Organ Sharing, 1100 Boulders Parkway, Suite 500, Richmond, VA 23225. Telephone: (804) 327-1432.