Survey shows dilemmas in deciding whether to get organs after death

CHICAGO (AP) -- Deciding you want to donate your organs after death is no guarantee it will happen, especially if your relatives object.

A government survey of the nation's 61 organ procurement organizations found wide variations in how they decide whether to remove organs from the dead for transplant. Just 29 of the groups have an official policy on whether to follow the wishes of the deceased or of family members.

If a person had indicated in a living will or on a donor card that he wanted to be a donor but his survivors opposed it, only seven groups -- 12 percent -- said they would probably remove the organs.

Fifty-two of the groups surveyed -- 85 percent -- said they rarely have documentation of the deceased's wishes. And when they do, 51 of them -- 84 percent -- said families do not always go along with the deceased's wishes.

Every state has adopted some form of the Uniform Anatomical Gift Act, which favors the wishes of donors. But Susan Gunderson, president of the Association of Organ Procurement Organizations, said laws generally give wide latitude to procurement groups.

The private organizations surveyed in 1999 are in charge of organ procurement from cadavers throughout the country. The survey was done by Dave Wendler and Neal Dickert of the National Institutes of Health's department of clinical bioethics and was published in Wednesday's Journal of the American Medical Association.

Procuring organs from the deceased is a delicate process, fraught with emotion for all involved, said Phil Van Stavern of the Oklahoma Organ Sharing Network, one of the procurement groups.

Typically, the prospective donor has died suddenly and unexpectedly. Procurement coordinators often enter the scene in the hospital waiting room, where survivors have just learned of their loved one's death.

"The family's in shock, they're grieving, and we're being very invasive," Van Stavern said. Defying the family's wishes under such circumstances is very difficult, he said.

To ease the process, prospective donors should "make sure they tell their family what their wishes are," both orally and in writing, Van Stavern said.

The findings come amid efforts to address the nation's scarce supply of transplant organs.

In 1999, for example, 6,448 of 72,255 people on transplant waiting lists died by the end of the year while awaiting an organ, according to the United Network for Organ Sharing, which runs the nation's transplant network.

A national debate has focused on how to distribute donated organs, but most people agree that the best solution is to increase donation. In a JAMA editorial, University of Southern California ethicist Alexander Capron said the survey bolsters suggestions that weaknesses in the procurement process have contributed to the shortage.

------ On the Net: JAMA: http://jama.ama.assn.org AOPO: http://www.aopo.org UNOS: http://www.unos.org