Context Understanding the consent process that organ procurement organizations
(OPOs) use is crucial to improving the process and thereby reducing the number
of individuals who die each year for want of an organ transplant. However,
no data exist on OPOs' current consent practices.
Objective To assess whose wishes OPOs follow when procuring solid organs from
deceased individuals and whether advance directives and computerized registries
might improve the consent process for solid organ procurement.
Design, Setting, and Participants Telephone survey conducted from June to August 1999 of all 61 active
Main Outcome Measures Responses to the 49-question survey addressing consent practices in
specific scenarios of deceased and next of kin wishes.
Results Widespread divergence exists in OPOs' consent practices for cadaveric
solid organ procurement. Regarding overall consent practices, 19 (31%) OPOs
reported that they follow the deceased's wishes, 19 (31%) follow the next
of kin's wishes, 13 (21%) procure organs if neither party objects, 8 (13%)
procure organs if either party consents or neither objects, and 2 (3%) do
not follow any of these 4 overall practices. These differences appear to be
traceable to implicit ethical disagreements about whose wishes should be followed.
A total of 29 (48%) OPOs reported having an official policy to address whether
they follow the family's or deceased's wishes. Regarding factors that influence
OPOs' choice of consent practice, 29 (48%) respondents ranked impact on the
deceased's family as the most important factor, 13 (21%) ranked state law
as most important, and 7 (11%) ranked the priority of the deceased's wishes
as most important. Durable power of attorney appeared to have substantial
weight in OPOs' decisions; for example, in the scenario in which the deceased
supported organ donation and the next of kin opposed it, 34 (56%) OPOs reported
they were likely to procure organs based on the consent of the holder of the
deceased's durable power of attorney, whereas only 7 (11%) reported they were
likely to procure organs based on a document of gift (a living will, donor
card, or driver's license).
Conclusions Expanding the legal scope of living wills to cover individuals' organ
donation preferences would likely have little impact on procurement rates.
In contrast, expanding the legal scope of durable powers of attorney for health
care may have a significant impact. A national discussion should take place
addressing the underlying ethical issues that appear to account for much of
the divergence among OPOs' consent practices for cadaveric solid organ procurement.