Police in Southern California and the state Medical Board are investigating whether a transplant surgeon prescribed drugs to hasten the death of a 26-year-old patient in order to harvest his organs more quickly to ensure they would be transplantable. What the doctor is alleged to have done is wrong and, if proven, merits strict punishment.

The public needs to be able to trust doctors to make dying as painless and dignified as possible. And to trust that they’ll follow patients’ wishes about medical care at the end of their lives. That is why a proposed change in state laws governing organ donation is not a good idea.

Many Americans, while supporting organ donation, have doubts about whether they will receive appropriate care if they identify themselves as organ donors. The frightening story from San Luis Obispo was being joked about on a sports radio station in Philadelphia just the other day. The message: Don’t sign an organ donor card or check your driver’s license to be a donor because doctors may kill you to get your parts!

We agree with the 85 percent of Americans who respond in polls that organ donation after death is a good thing. Donation helps provide some redemptive value to death, makes grieving less burdensome for family members and, of course, saves lives. But causing death to maximize organ donation is violating all ethical standards governing organ procurement. Fear of this may cause people to revoke or not provide
consent, and that jeopardizes thousands of lives.

Recently, a private but influential legal group, the National Conference of Commissioners on State Laws, revised the Uniform Anatomical Gift Act (UAGA), which is the model that many states have followed to legislate organ donation. The commissioners know there are too few organs available for those in need. Their proposal, which is under consideration by states, is that organ donation consent (on a driver’s license, for instance) be allowed to override a person’s living will, advance directive or even physician orders. The proposed language in the revision states, “measures necessary to ensure the medical suitability of an organ for transplantation or therapy may not be withheld or withdrawn from the prospective donor.” What this means is that if you say you are willing to donate your organs, your advance directive, living will and physician’s orders are in trouble.

The revised UAGA, which is under review by the California Department of Health Services and the state Legislature, in one fell swoop nullifies the advance directive of people who have consented to organ donation. If California and other states adopt the revised UAGA as written, advance directives will have to make clear whether the person gives more importance to organ donation or to directions about their end of life care. That is too much to ask.

People have clear opinions on their end-of-life care, including preferences for advanced life support and palliative medications, but also, organ donation. When making organ donation consent at a motor vehicles licensing office in San Jose, Los Gatos or Hollister, people are not asked whether the organ donation should nullify their living will. To assume otherwise makes no sense.

The commissioners may further revise their published recommendations to acknowledge their position that quality end-of-life care is as important as organ donation. They are thinking of adding language that organ-procurement professionals work with critical care physicians and families to try to find a course that promotes both excellent care as patients die and the opportunity to donate organs.

That collaboration is important, but it is essential that the line between caring for the dying and obtaining organs for those in need remain sharp and bright. One of the biggest barriers to obtaining consent for organ donation in California and around the nation is the fear that the consent will lead doctors to make end-of-life decisions based on what is best for organs rather than patients. That is what is troubling about the death in Southern California of Reuben Navarro. That fear should never become the law in California or any other state.
-Art Caplan [from San Jose Mercury News]