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SOURCE: National Conference of Commissioners on Uniform State Laws | The Washington Post - September 13, 2007

New Zeal in Organ Procurement Raises Fears

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By Rob Stein
Washington Post Staff Writer
Thursday, September 13, 2007

After a long fight with a degenerative disease, Ruben Navarro appeared close to death. So the 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.

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But as Navarro hung on, tension mounted in the operating room of Sierra Vista Regional Medical Center in San Luis Obispo, Calif. 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 A. 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. "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, or OPOs. 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.


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