The shortage of organs for transplantation: where do we go from here?

Article Abstract:

Kidney transplantation is the optimal treatment for people with irreversible, complete kidney damage, yet the supply of organs is becoming increasingly inadequate to meet the need. Almost 24,000 patients currently wait for organs in the US, with 19,000 of them needing a kidney. This number is at variance with the decline in kidney transplantation procedures noted in the latter 1980s. The problem is not one of donor shortage but, rather, the difficulty in turning potential donors into actual ones. What could be done to improve the system of organ procurement? Most kidneys and other organs are procured from cadavers and donation is voluntary. The Uniform Anatomical Gift Act, drafted more than 20 years ago, allows adults to donate their organs, but its effectiveness remains limited. Many people never consider donating organs, and fewer than 15 percent of the public carry donor cards. Emergency medical personnel often neglect to search for such cards; even if a card is found, most programs require consent from the next of kin. Even when legislation has been passed that requires hospital personnel to ask families of appropriate deceased persons to consider organ donation, results are not much better. It is possible that a policy of presumed consent (for donation), rather than presumed refusal, would be better. Although such an approach has helped increase the supply of donated organs in Europe, it is not popular in the US, and in many European countries, the family is still often consulted. The author suggests an alternative approach, which would ask applicants for driver's licenses to determine whether they would object to having their organs removed for transplantation in the event of death. The response would be printed on the license, with the possibility of indicating a change of mind. The family would only be involved if the person had no driver's license. The support of the public for such a measure would be essential, but some surveys have indicated that this is likely. Surveys also show that people are quite altruistic. It is time to rewrite the laws of organ procurement so that they benefit the living, allowing them to benefit from modern advances in transplantation medicine. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Routine inquiry about organ donation - an alternative to presumed consent

Article Abstract:

More than 22,800 people currently await organ transplants in the US, and the list grows longer every year. The Uniform Anatomical Gift Act, which requires consent for organ donation, has not provided enough organs to meet the demand. The concept of presuming that the deceased would donate organs is now receiving more favorable attention than in the past. However, this approach is not yet appropriate and other remedies should be tried to increase the supply of donated organs. There are clearly cases where to presume consent would be wrong, and the doctrine of presumed cannot be generalized to organ donation. Surveys have shown that 85 percent of respondents would donate a loved one's organs; therefore, presumably 15 percent would not. In the same poll, only 60 percent said they would donate their own organs, and in actual hospital settings, the donation rate is much lower. Moreover, presumed consent will not result in more organs if the family of the deceased is still asked for consent, since the same people, then as now, will probably object. People found dead without family members would be the only increased source of organs. Alternatives to presumed consent include maximizing actual consent by improving organ procurement programs. This can be facilitated by institutions' becoming better at gaining the trust of patients and their families and encouraging them to file donation cards as specified in the Uniform Anatomical Gift Act. In most states, the next of kin must be asked for permission for organ donations. This removes the responsibility for donation from the potential donor, lodging it with a surrogate. A better approach is to systematically inquire of competent adults regarding the disposition of their bodies after death. Discussions of organ donation could become routine, and this sensitive issue should not be avoided. The problem could be raised in other contexts, such as when the person applies for a driver's license. A sense of community obligation should be fostered concerning organ donation. Even a policy of routine organ retrieval is preferable to pretending we can presume consent. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Consent, confidentiality, and research

Article Abstract:

Many medical researchers may be violating patient confidentiality when doing clinical studies. A 1997 study of a group of physicians who offered patients genetic testing found that many did not receive written consent from the patients and did not offer counseling before the test. But it is not clear whether these researchers told the physicians the nature of the study or received their consent to participate. It is not clear whether the patients who were tested consented to let the researchers see the results of the test. This raises serious ethical questions about many research studies.

Editorial, Medical research, Medical records, Access control, Informed consent (Medical law), Informed consent

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