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No 'Magic Bullet' in Organ Donation Choice

Many factors involved, including family's knowledge

TUESDAY, July 3, 2001 (HealthDayNews) -- Someone is in a hospital intensive care unit, near death because of a stroke or severe brain injury. The family has gathered, and the question of organ donation -- heart, kidney, liver, or whatever -- comes up. What will influence the yes-or-no decision?

No one single factor, says a study of 420 donor-eligible cases in nine hospitals, including interviews with family members, doctors, nurses and staff members of organ procurement organizations.

"We were looking to see whether there was some magic bullet out there that would make people decide to donate. Instead, we found a number of addressable factors," says lead study author Laura A. Siminoff, professor of medicine and bioethics at Case Western Reserve University School of Medicine. Findings are reported in the July 4 Journal of the American Medical Association.

Patients in the study donated 238 organs. "Yes" answers were more likely for younger, male, white patients whose death was caused by trauma rather than by disease.

But beyond that, the decision is influenced by the way the family is approached in the hospital, and Siminoff says health-care providers need to be aware that "when you ask, it is not enough just to say, 'Do you want to donate?'"

Success is more likely when families are assured that donations will not cost them money, and that they can choose which organs to donate, Siminoff says. Families also want assurance that the procedure will not be disfiguring. Most families want that kind of information, and once they are given information, "they need to be given time to think about it, to have a discussion," she says.

The most effective provider of information is not a doctor or nurse, but a specialized organ coordinator, the study found. "This isn't something doctors and nurses are trained to do," Siminoff says.

Families who were aware of the patient's wish for organ donation were more likely to say yes, but "most patients did not have donor cards," Siminoff says. "Some had donor cards, but no one in the family knew it. Just signing a donor card may not be sufficient. Most states do not have registries. You need to tell someone about it."

That's especially important, says Melissa Devenny, assistant director of the Coalition on Donation, an advocacy organization, because "in many cases the donor card is not found on the person, because death often is the result of major trauma, so the wallet is in the hands of the police."

Meanwhile, Devenny says the donor pool "is shrinking on an almost daily basis." Until recently, only persons declared brain-dead were candidates for organ donation, but, ironically, a reduction in violent crime and improvements in auto safety have reduced the number of those candidates, says Devenny.

"Of the 2 million deaths annually in this country, less than 1 percent will result in organ donation, because of the criteria by which death is declared," Devenny says.

An increase in donations by living donors has helped fill the gap, but the number of people waiting for organs over the last decade has increased 70 percent, Siminoff says.

What To Do

"The first thing people need to do is to educate themselves about organ donation and then make a conscious decision and relay that decision to the family," Devenny says.

To learn more about signing up for organ donation, go to the Coalition on Donation or the U.S. Department of Health and Human Services.

SOURCES: Interviews with Laura A. Siminoff, Ph.D., professor of medicine and bioethics, Case Western Reserve University School of Medicine, Cleveland, and Melissa Devenny, assistant director, Coalition on Donation, Richmond, Va.; July 4, 2001, Journal of the American Medical Association
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