Friday, March 16, 2007

Organ Donor Cards to Overrule Advance Directives?

Bioethicists Art Caplan and Michael A. Devita have written an important column warning against plans that are afoot to increase the organ supply, but which if enacted, would instead be more likely to undermine the already thin crust of trust the people have in the organ procurement system.

Apparently, a proposal is being crafted that would alter the terms of the Uniform Anatomical Gift Act, a "model law" which states often follow in crafting their respective public policies. The proposal would give priority to the signing of organ donor cards. Caplan and Divita explain what this could mean: Their proposal, which is under consideration by states, is that organ donation consent (on a driver's license, for instance) be allowed to override a person's living will, advance directive or even physician orders. The proposed language in the revision states, "measures necessary to ensure the medical suitability of an organ for transplantation or therapy may not be withheld or withdrawn from the prospective donor." What this means is that if you say you are willing to donate your organs, your advance directive, living will and physician's orders are in trouble. In other words, if these recommendations become law and you sign an organ donation card, preserving your organs could become the primary consideration in determining your medical care--which could either prevent you from receiving treatment you might want, or be forced to accept interventions you would not want.

This is nuts. If people ever come to feel that their organs might be seen as more important than their own medical welfare, they will rip up their organ donation cards en masse. Good for Caplan and Devita for bringing this important matter to public light.



At March 17, 2007 , Blogger Lydia McGrew said...

I wonder if the people crafting this stuff are deliberately trying to be sneaky. It makes it sound like you'd get _better_ care--"measures...shall not be withheld." But of course, as you say, it might mean just the opposite. There's something very unhealthy about the frantic drive to get more organs.

At March 17, 2007 , Blogger T E Fine said...

And of course, putting organ donation ahead of living wills and advance directives will go against many people's religious, cultural, and ethical beliefs, but nobody cares about that. I saw an episode of CSI (the Vegas series) where one member of the team refered to doctors harvesting organs for donation as "the vultures," and the rapid pace at which they harvested the organs disrupted an investigation - at the time (having my name on an organ donation card myself), I thought it was unjustly harsh toward organ donation, but the more I read the more that sounds like reality. I understand that we need more people to donate organs to help save lives, but you can't measure one person against another and say, "S/he is more important than the guy we're getting the organs from."

At March 17, 2007 , Blogger Wesley J. Smith said...

The irony is that the less than ethical proposals would actually reduce organ donation, because people would have less trust in the system.

At March 21, 2007 , Blogger Stephen Drake said...


I posted this on the bioethics blog as well, but I can never tell when they'll actually let one of my comments through on the blog.

Kudos go to Caplan and his colleage for the alert and their analysis.

But they missed something that's even more troubling, at least to me. According to the NCCUSL website, the UAGA has been endorsed by the AMA, the United Network for Organ Sharing, the National Kidney Foundation, the Eye Bank Association of America, the American Association of Tissue Banks, the American Academy of Ophthalmology, the Cornea Society, and the Association of Organ Procurement Organizations.

Did these organizations actually *read* this policy before endorsing it?

I don't know which is worse - the thought that they didn't bother to read it or that they read it, understood it, and endorsed it anyway.


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