Despite strong support by the U.S. government for organ donation, not nearly enough organs are ever available to meet the needs of all those on waiting lists. Yet thousands of potential donors die in hospitals across the country every year.
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Organ procurement organizations can counsel families of terminal patients
One of the reasons for these missed opportunities is that physicians attending patients who are potential donors are sometimes so focused on treating them that they dont think about donationand, in some cases, they actually prevent it.
But as most hospital administrators are painfully aware, terminally ill patients are too often kept in their beds by doctors who are reluctant to tell them or their families the truth about their situationor who pursue heroic measures when they know there is little or nothing to gain.
As a former hospital administrator now deeply involved with the organ donation cause, I wholeheartedly agree with the opinion recently expressed in the New York Times by a physician with years of experience in the emergency room and the intensive-care unit: I think doctors should get comfortable with being realistic.
Lack of realism about patients outlook can keep them in ICUs for days, weeks or even months. As hospital administrators must be aware, this often makes it impossible to accept other patients who urgently need intensive care. That problem could be alleviated if more doctors better understood organ donation and made it an integral part of compassionate end-of-life care.
Obviously, no physician wants to say to the family of such a patient, Theres no use in providing further treatment for him. Now, let us have his organs. They should never have to make that request. All a doctor needs do is use a resource available to all physicians attending terminally ill patients in hospitals: The nearest of the 58 organ procurement organization, or OPO, across the country.
The OPO gets involved when it is notified by a hospital that it has a patient who has suffered a severe neurological injury, been placed on a ventilator and is considered unlikely to recover. It sends out representatives to monitor such patients condition and makes sure that even if nothing can be done to prolong the patients life, steps will be taken to maintain the organs should consent for donation be given by the next of kin.
Another OPO representative, known as a family-care coordinator is there to comfort the families of the victim in their time of grief, to offer whatever assistance they might request and, when it appears appropriate, to seek permission for donation.
The presence of the family-care coordinator makes the attending physicians job much easier and less time-consuming. After explaining to a victims family that their loved one is brain dead, the coordinator can say to them, Now Im going to introduce you to someone who can be very helpful to you at this very difficult time.
This process provides time for families to digest the news and makes it unnecessary for the doctor to mention donation, which is usually regarded as an unpleasant task or possibly a conflict of interest. It also relieves the physician of having to spend precious time further explaining brain death to the patients next of kin, who are often unable to understand that condition while they are still in shock.
The family-care coordinators are used to dealing with that situation. They are accustomed to relatives looking at their loved one on a ventilator and saying, How can he be dead when I can see him breathing? His hand is warm and his heart is beating.
It is the coordinators task to explain to the family that the loved one cannot ever recover, that the person is medically and legally dead. Quite often this explanation must be repeated again and again, sometimes over a day or two. In most situations, the family will finally come to face reality.
Usually, after brain death is initially explained to the patients family, the family-care coordinator will broach the subject of organ donation, explaining how that can enable their loved one to live on in the bodies of as many eight people who might otherwise die. But the coordinator is trained never to badger families about donation if they have chosen not to do so. And even if consent for donation is denied, the coordinators will remain with families for hours or even days to provide comfort and assistance.
It should be apparent then that the coordinator can lift an enormous burden from the doctor, the nurses and the rest of the hospitals staff, while allowing donors families to find peace in the knowledge that their loved one has helped others. Thus doctors and nurses should have no regrets or concerns about introducing the families of a terminally ill or injured patient to the OPO.
I hope this discussion will motivate hospital administrators to help doctors become comfortable with reality in the treatment of terminal patients and to be aware that their local OPO can be a valuable resource. This would not only cause more beds to become available for intensive-care patients; it would also result in a substantial increase in the number of organs available for those who desperately need them.
Thomas Mone is CEO of OneLegacy, an organ procurement organization based in Los Angeles. He is a director of the United Network for Organ Sharing.
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