New Zeal in Organ Procurement Raises Fears

"In some places, the organ-procurement folks will actually go into the room and meet the family and wear scrubs that are the same color as the hospital personnel and allow themselves to be experienced by the family as being members of the hospital staff," said Daniel O. Dugan, a bioethicist who advises hospitals in California and Illinois. "They will introduce themselves and build a kind of rapport when actually their whole agenda is organ procurement."

Some OPOs say their representatives always identify themselves immediately, but others acknowledge that practices vary.

"There is great debate on that topic," said Mone, who heads the OneLegacy OPO in Southern California. "Sometimes simply mentioning it will send a family into shock. It may not be appropriate to put that stress on a family at that time."

Once they have made their role clear, many organ procurers use what some consider a high-pressure pitch. In what is known as the "dual advocacy" approach, OPO representatives are increasingly trained to try to persuade families to consent by describing dying patients desperate for organs. They also take a "presumptive" approach that assumes the family would want to donate.

"They can definitely get overzealous at times," said Eric Gluck, director of critical care services at the Swedish Covenant Hospital in Chicago. "I have seen these guys come in and almost browbeat families into submission to get them to donate organs."

Some say the newly aggressive stance makes them especially uneasy because it comes amid a campaign to rewrite state laws governing organ donation to give OPOs more power. In addition, they note, organ donor advocates have been pushing a controversial practice known as " donation after cardiac death," which involves patients who have not been declared brain-dead but are being kept alive with a respirator.

That was the case with Navarro. Severely disabled, he was put on a respirator after being taken to the hospital on Jan. 29, 2006, from a nursing home, where he had been found without a pulse. When doctors told his mother, Rosa, that there was no hope, she agreed to allow him to become a donor.

But she was shocked when she heard what happened next. Her son's heart kept beating even though his ventilator had been removed and the multiple doses of drugs had been administered. Roozrokh also allegedly administered through a feeding tube in Navarro's stomach an antiseptic normally used to sterilize a donor only after death. The doctors eventually gave up and wheeled him back to his room, reportedly as he frothed at the mouth and shivered.

The transplant surgeon's attorney, M. Gerald Schwartzbach, defended Roozrokh in a written statement, denying that he did anything to hasten Navarro's death and calling the charges part of a "witch hunt." Roozrokh pleaded not guilty yesterday to two of the three felony counts he faces.

Officials at the California Transplant Donor Network declined to comment. But Phyllis Weber, who headed the organization, said the actions violated the group's policies.

In an e-mail forwarded by her attorney, Rosa Navarro said: "I hope by this case that the doctors and the hospital and the organ transplant network learn that they need to treat people with dignity." She is suing the hospital, the doctors and the organ network, among others. "This type of thing should never happen to anyone else or their loved ones again."

Previous articles on new state laws governing organ donations and "donation after cardiac death" are available atwww.washingtonpost.com/science.