Organ donation: The physician factor

Most attention on transplantation is focused on donors. The AMA is taking an important inward look on the role of doctors.

Editorial. May 21, 2001.

The latest organ transplant figures are in and they are up. Yet even these increased numbers underscore how very far there is to go before the enormous potential of organ donation will be realized.

Most striking, the number of cadaveric donors posted only a modest 2.7% increase in 2000 from the year before, according to the Dept. of Health and Human Services. This despite public campaigns to increase organ donor awareness -- HHS announced a major new initiative the day after these numbers were released -- and 1998 government rules to promote the involvement of organ procurement organizations, or OPOs, when a patient death is imminent.

Meanwhile, the number of living donors rose 16.5% -- the biggest one-year increase ever -- to more than 5,500 cases, up to almost the number of cadaveric donors. The sharp rise in live transplant donors is, at least in part, itself a reflection of the chronic shortfall in cadaveric organs.

The concept of organ donation is simple, but the procurement of cadaveric donors has proved to be complex. Organ donation appears to have widespread appeal in the abstract, but few individuals actually sign donor pledge cards. Others sign but omit the crucial step of letting loved ones know of their decision. Absent proof of intent, families are confronted by not only the sudden loss, but also with the need to make what for many is a difficult decision about donation. More than half say no. [...]