Texas mulls policy for organ donation by presumed consent

While the first-in-the-nation bill stands little chance of passing, it promises to heat up ethics debates.

By Andis Robeznieks, amednews staff. April 28, 2003.

A bill authorizing a controversial method of increasing organ donation has been introduced in Texas and, although its chances appear slim, proponents plan to offer persuasive testimony that they hope will sway lawmakers to their side.

State Rep. Mark Homer introduced a bill calling for Texas to adopt a "presumed consent" policy, meaning it's assumed that adults agree to be organ donors unless they have officially recorded their desire not to donate. It's a contentious policy, but presumed consent has been credited with increasing organ donations in Europe. The three nations with higher donation rates than the United States -- Spain, Austria and Belgium -- all have presumed consent.

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Presumed consent supporters are also actively working to get bills introduced in California, New York and Rhode Island, but -- since transplant activists have been particularly vocal in Texas -- current thinking is that Texas may offer them the best chance for a legislative victory.

Homer said he became interested when a friend's child died of leukemia after efforts to find a bone marrow donor failed. "It kind of started there, and we stepped down and said 'Let's address the transplant issue,' " the Texas Democrat said. "We're going to push it as hard as we can."

According to the United Network for Organ Sharing, 6,434 people in the United States died last year (more than 17 a day) waiting for an organ transplant, including 431 Texans. Homer said presumed consent would "expand opportunities for survival."

Putting the idea "out there"

Although Texas is home to the Presumed Consent Foundation and an established network of organ transplant support, Homer introduced his bill without their input.

Texas Transplantation Society Executive Director Laurie Reece said that the TTS (a sister organization of the Texas Medical Assn.) is not taking a position on the bill, but she said the organization was pleased that Homer introduced it.

6,434 people in the U.S. died last year waiting for an organ transplant.

"We think it's a good idea Homer has filed a bill because it will get the debate started and increase awareness," she said. "He told us he didn't think it has much of a chance legislatively, but it was a good enough idea that it should be put out there and have people debate it."

The TMA did not take a position on the bill. TMA spokesman Brent Annear said the Legislature's agenda was so packed with health care-related bills that the TMA decided it had to "choose its battles wisely" and focus on the ones that affected more people.

But the PCF completely supports the bill. "I've been told I must be crazy, but I think the time has come," said PCF Vice President David Courtney of Plainview, Texas. "We have discussed it for so long, and our population in Texas is very aware of the organ donation crisis nationwide."

Courtney is recruiting transplant patients to lobby for the bill. Two prominent liver transplant recipients already in his corner are actor and Fort Worth native Larry Hagman, and Dallas surgeon and former TMA President Phil Berry Jr., MD.

Hagman recently narrated a PCF public service announcement that Courtney said he's putting on 5,000 compact discs for distribution to television and radio stations.

Dr. Berry, who belongs to the U.S. Advisory Committee on Organ Transplantation, was seen as a driving force behind the AMA House of Delegates' decision to endorse studying whether modest financial incentives would boost organ donations. Dr. Berry vowed to keep his remarks to the Legislature simple and direct.

"I get back to the single biggest issue: We're not winning this battle," he said. "There are more people dying waiting for organs than the year before. It's imperative that we look at every possible solution -- including presumed consent."

If Texas does pass presumed consent, it wouldn't necessarily be violating AMA organ donation policies.

AMA prefers mandated choice

Issued in 1994, AMA policy prefers "mandated choice," in which individuals are required to express their organ-donation preference while renewing a driver's license or some other task. But it doesn't rule out presumed consent entirely.

"For presumed consent to be ethically acceptable," the policy states, "effective mechanisms for documenting and honoring refusal to donate must be in place." If no documentation exists, it states that the decedent's family should be contacted.

Leonard Morse, MD, chair of the AMA Council on Ethical and Judicial Affairs, agrees with the policy, but he said putting presumed consent on the agenda for the CEJA open forum at the AMA Annual Meeting this June may help boost awareness of organ donor issues.

"It's almost 10 years later, we should revisit it," Dr. Morse said. "The ethical concerns are that you do a procedure on a dying person who has expressed an unwillingness to participate. If a person has said they didn't want to give their organs, that should be respected. That's why it's important to speak to the family."

ADDITIONAL INFORMATION:

Weblink

Presumed Consent Foundation (www.presumedconsent.org)

U.S. Dept. of Health and Human Services Advisory Committee on Organ Transplantation (www.organdonor.gov/acotrecsbrief.html)

CEJA report "Strategies for Cadaveric Organ Procurement: Mandated Choice and Presumed Consent," in pdf (www.ama-assn.org/ama/upload/mm/369/ceja_report_055.pdf)