Last year, the House of Delegates affirmed ISMA’s longstanding policy of encouraging all physicians and more Hoosiers to become organ donors. The need remains great. More than 1,200 Indiana residents are awaiting lifesaving organ transplants: 1,007 for kidneys, 94 for livers, 69 for hearts, 33 for kidneys and pancreases, 17 for pancreases, 20 for intestines, and four for lungs, according to the Indiana Donor Network. In addition to registering as organ donors themselves, physicians can help save lives by educating patients about the importance of organ donation.
“In fulfilling their obligation to promote health and well-being, physicians should be inclined to discuss donation in an attempt to increase donation rates and mitigate the organ shortage,” commented the authors of a 2012 case study in the AMA Journal of Ethics. “Promoting organ donation serves both individual patients, who very well may need an organ, and society, by decreasing the financial and human costs of many life-threatening conditions.”
Understanding how and when to talk to patients about organ and tissue donation is the first step for physicians who want to help, said Duane Brodt, media relations and communications specialist at Indiana Donor Network. “Unintentionally providing incorrect information about the organ donation process could be instrumental in someone deciding against becoming an organ donor,” he said.
Physician, patient concerns
Chapter 6 of the AMA Code of Medical Ethics, maintained by the AMA Council on Ethical and Judicial Affairs, makes clear that efforts to increase organ donation must protect the interests of living and deceased donors. Transplantation also requires protecting organ recipients’ interests. Numerous opinions in the Code of Medical Ethics address these concerns as well as the ethics of organ donation after cardiac death, transplantation from living donors, directed donation of organs, presumed consent and mandated choice for organs from deceased donors, and more.
Brodt said misconceptions and concerns about organ donation exist across all segments of the population but particularly among minority groups, who make up more than 60% of the national transplant waiting list. At the same time, members of minority groups are disproportionately affected by hypertension and diabetes, which increase the risk of needing a transplant. According to Donate Life America, 28% on the national list are African American or Black, 21% are Hispanic or Latino and 9% are Asian or Pacific Islander, while fewer than 1% are American Indian or Alaska Native and fewer than 1% are of multiracial descent.
“Organ transplants can be successful regardless of the ethnicity of a donor and recipient,” Brodt said. “But chances of longer-term survival could be greater if a donor and recipient are closely matched in terms of shared genetic background. That is why diversity in organ donation is important. And that is why we need more donors of color to say yes to becoming an organ donor and saving lives.”
To put two common misunderstandings to rest, the organ allocation process does not discriminate based on race, wealth, social status or other uncontrollable factors, Brodt said. Instead, a computerized matching system selects recipients based on blood and tissue typing, organ size, medical urgency, waiting time and geographic location. Nor will organ donation interfere with customary funeral plans, including an open casket.
Sometimes, people mistakenly believe they’re not eligible to donate organs if they are aging or have been treated for serious medical conditions, Brodt said. But perhaps the most widespread concern is whether a person’s life will be saved if medical staff know they are a registered organ donor.
“There should be a clear understanding that one’s physician is doing everything they can to save their patient's life,” Brodt said. “A major part of our community education initiatives is informing potential donors that the medical team in charge of saving their lives is a completely different and separate team from one that discusses the possibility of donation and manages the donation process.”
When to discuss donation
The context in which a physician addresses organ donation registration with a patient is important. It would be appropriate to encourage registering as an organ donor during a routine office visit, but not appropriate at the bedside of a hospitalized patient who could be terminally ill, Brodt said.
In the event that a physician determines a patient will not live, they may introduce the patient’s family to Indiana Donor Network team members to begin discussions about donation.
“This process aims to transfer the relationship, trust and credibility the patient’s doctor has with the patient's family to Indiana Donor Network, thus ensuring that the family knows that Indiana Donor Network is a trusted source,” Brodt said. “It also allows the doctor to continue care of the patient until death is declared.”
Physicians can partner well with trained organ procurement staff to have conversations about donation that will encourage patients and family members to say yes to the decision to save lives, Brodt said.
“We want to partner with physicians to plan for donation conversations that will positively support the opportunity for organ and tissue donation to be full of hope and meaning, while saving lives.”
Resources for physicians
AMA Journal of Ethics: “Family Physicians’ Role in Discussing Organ Donation with Patients and the Public” (PDF) >>
AMA Code of Medical Ethics: Organ Procurement and Transplantation >>
Donate Life Indiana >>
Donate Life America >>
United Network for Organ Sharing >>
Indiana Donor Network resources
Facts about Organ Donation (PDF) >>
Facts about Tissue Donation (PDF) >>
Organ Donation Process (PDF) >>
Organ Procurement Organization Oversight (PDF) >>
Organ Procurement Services (PDF) >>