Organ procurement is becoming more aggressive

[okarol]

 Posted on Thu, Sep. 13, 2007

Organ procurement is becoming more aggressive

By ROB STEIN
The Washington Post

WASHINGTON | After a long fight with a degenerative disease, Ruben Navarro appeared close to death.

So the San Luis Obispo, Calif., hospital caring for him alerted the local transplant network, which rushed a team to the medical center to try to salvage the 25-year-old’s organs.

But as Navarro hung on, tension mounted in the operating room. With time slipping away, one of the transplant surgeons ordered repeated doses of the narcotic morphine and the sedative Ativan, jokingly calling the drugs “candy,” according to police reports. Navarro eventually died, but too late for his organs to be useful.

Horrified nurses complained, prompting multiple investigations. In July, prosecutors charged Hootan Roozrokh with trying to hasten Navarro’s death, marking the first time a surgeon has faced criminal charges in a transplant case.

No one thinks the Navarro case is typical, but it comes as transplant advocates are becoming increasingly aggressive in their efforts to procure hearts, livers, kidneys and other organs in the hope of saving more of the thousands of desperate Americans who die languishing on waiting lists.

For some doctors, nurses and medical ethicists, it represents their worst fear — the extreme end of a spectrum of practices that have been raising alarm in hospital wards, emergency rooms and intensive care units around the country.

“This is what we’ve been worrying about,” said Michael DeVita, a University of Pittsburgh critical care specialist. “If you promote organ donation too much, people lose sight that it’s a dying patient there. It’s not just a source of organs. It’s a person.”

Organ-donation agencies condemn the Navarro case and argue that they walk a careful line between advocating effectively for those who need transplants and violating ethical boundaries meticulously calibrated to protect dying patients and their families.

“That case appears absolutely to be a case of a transplant recovery surgeon crossing a very clear line that should never be crossed,” said Thomas Mone, president of the Association of Organ Procurement Organizations, based in McLean, Va. “Our job is to recover organs and save lives. But we have to do that sensitively, honestly and fairly, keeping the interests of the donors and families in mind. There’s often a fine line there, but we make sure we never cross it.”

Even the critics agree that most organ-donation advocates are acutely sensitive to ethical concerns, help save many lives, and enable families to find solace in their losses. But they worry that disturbing lapses may be increasingly common.

“The greatest fear the public has when it comes to organ donation is their loved one will not receive aggressive treatment and will wind up having their death hastened because of the zeal people have to get organs,” said Arthur Caplan, a University of Pennsylvania bioethicist. “You create a tremendous fear on the part of the public whenever any crossing of that line takes place.”

The more aggressive drive for organ donations grew out of a federal campaign known as the Breakthrough Collaborative, which the Department of Health and Human Services launched in 2003. The project was designed to boost the number of organs retrieved by the nation’s 58 organ-procurement organizations. These private, nonprofit, government-authorized entities deploy nurses, social workers and other specialists to identify potential donors, obtain consent from families, and work with doctors and nurses to recover as many organs as possible.

“We launched this initiative because the waiting list was getting longer and longer,” said Ginny McBride of the Health Resources and Services Administration. “The bottom-line goal is to save more lives.”

Since the campaign began, doctors, nurses and others say they have noticed a clear change.

“The demand for organs is very intense, and the organ-procurement organizations have become much more aggressive about supplying it,” said David Crippen, who heads neurocritical care at the University of Pittsburgh Medical Center.

Most hospitals now have detailed criteria that automatically trigger a call to the local organ-procurement organization within the first hour after a potential donor is identified. Hospitals also regularly get reports rating their performance.

In many hospitals, organ network representatives now routinely comb through patients’ records looking for potential donors.

“It’s like they’re vultures flying around the hospitals hovering over beds waiting for them to die so they can grab the organs,” said Michael Grodin, a Boston University bioethicist. “That’s the impression you get sometimes.”

Organ-procurement advocates argue that nothing is done that would harm a potential donor, and that any testing is aimed at saving families from agonizing about a donation only to find out that their loved one was not eligible.

http://www.kansascity.com/news/nation/story/274418.html

[okarol]

 Posted on Sun, Sep. 30, 2007

AS I SEE IT: Organ-donation story is full of compassion and joy

By LISA PARKS

My husband and I were disappointed and deeply saddened by the article (9/14) “Organ procurement becoming more aggressive.”

The timing was particularly difficult because the story ran the same day as the memorial service for our beautiful 32-year-old daughter, who passed away Sept. 8.

We feel so fortunate that she was able to donate her heart, lungs and kidneys, and we know that her loss would have been unbearable without that. The fact that she was able to donate her organs, tissues and corneas has helped us make sense out of her sudden and very unexpected death. As we understand it, her organ donation has saved four lives and her tissues will possibly help 50 people.

While the article states that “No one thinks the Navarro case is typical,” we fear that news coverage may lead people to believe that the organ donation process is something they want to steer away from.

The case as it was described in the article is completely different from our experience. Because our daughter had expressed interest in being a donor while she was alive, the request to consider organ donation was initiated by us. No one was “hovering” over us. We were treated with the utmost courtesy and respect by everyone associated with the process and there was always tremendous sensitivity to the care of our daughter while we were exploring the possibility of her being a donor.

I know that many decisions go into determining what stories qualify as news that needs to be printed. A careful read of this story leads me to the conclusion that the only “news” in the story are the details of the Navarro case and the description of the federal campaign launched in 2003 — the Breakthrough Collaborative. Much of the article is opinion and speculation from various “experts.”

I would contend that our own story is much more newsworthy. It has all the elements of breaking news:

•The shocking and gut-wrenching loss of our daughter late on a Friday night.

•The amazing team from the Midwest Transplant Network that labored through the day and night Saturday to determine if our daughter was a candidate for donation and then found matches in the transplant databases.

•The three teams of doctors who flew in from three different cities on Sunday afternoon to recover the organs and return to their home cities to complete the heart and lung transplants within four hours of the initial surgery.

•And (we can only imagine this) the families of the recipients who got the news Sunday morning that their wait was over and that lives would be lengthened.

I am sure that there are countless other stories from many other families who have found comfort through organ donation. We would hope that these “typical” stories would find their way into the “A” section, so that the Kansas City community can benefit from more balanced news coverage of this timely and important issue.

http://www.kansascity.com/273/story/297654.html