New Zeal in Organ Procurement Raises Fears

"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. "I worry that some of the changes in the logistics of organ procurement could compromise public trust."

Most hospitals now have detailed criteria that automatically trigger a call to the local OPO within the first hour after a potential donor is identified. Hospitals also regularly get reports rating their performance. The campaign has increased the number of organ donations, but some doctors and nurses say the shift has been accompanied by a discomfiting rise in both subtle and overt pressure.

"I personally am very supportive of organ donation. But people I work with sometimes feel they are too pushy," said Mary Henman, an intensive care nurse at Meriter Hospital in Madison, Wis., stressing that she was not speaking on behalf of the hospital. "I think their enthusiasm for their ultimate goal kind of causes them to sometimes lose sight of the fact that the general public has some qualms about organ donation."

At Emanuel Medical Center in Turlock, Calif., neurologist Narges Pazouki said an OPO representative pressed her this summer to declare a patient brain-dead before the appropriate tests had been done.

"I told them, 'It's too soon for you to be involved. Let us do our job,' " Pazouki said.

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."

In some cases, OPO representatives request tests, such as HIV screening, of a patient without obtaining family members' consent, or ask doctors to administer blood pressure drugs or other medication to keep a possible donor's organs viable until their suitability can be determined and the family consent can be obtained.

"I worry about the care of the dying patient being dictated by the potential for organ donation," said DeVita, the Pittsburgh specialist. "By and large, I think OPOs are working hard to make sure that when organ donation can appropriately occur it does occur, which is important. But they have to be careful not to step over that line and get involved in the management of dying patients."

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.

"It can save a lot of time and effort on everyone's part, and save the family from the disappointment of being offered an opportunity and not have that opportunity come to fruition," said Eric Grossman, the New York Organ Donor Network's medical director.

Critics also worry about how OPO representatives interact with families reeling from the impending death of a loved one. Some representatives delay identifying their role, either initially letting families assume they are part of the hospital staff or being vague, saying only that they are "end-of-life" or "grief" counselors.