A young, newly married couple who had gone to their lawyer to make out new wills were surprised when she handed them a Uniform Donor Card to sign if they wanted to give their bodies or organs to medicine.
Being a progressive-thinking pair, they signed the cards without hesitation, had them witnessed and put them away in their wallets. But a day or two later, while looking over the wills, they asked each other:
"What have we done?"
Death is a scary thing to most people and offering up one's body or even a part can make it seem even more so.
"It's a very sensitive area. It has to be handled very sensitively," says Dr. B. R. Bhussry, chairman of Georgetown University's anatomy department.
Transplant specialists and Washington's medical schools are eager to reassure -- and possibly persuade -- potential donors. Medicine's need for organs and bodies is great and continuing.
Richard Filson, transplant coordinator for George Washington University Hospital, who works closely with similar coordinators at Howard, Georgetown, Washington Hospital Center, Walter Reed and Children's, stresses that efforts are made to treat the deceased's family with as much tact as possible. He doesn't doubt that some may perceive the organ request as "grisly," but "it's not a hard sell. The cadaver's family needs as much consideration as the kidney recipient."
The family of a 12-year-old girl who had died told Filson that the only consolation in their grief was that her kidneys could be used by someone who needed them. In talking to potential donors, he says, he has found their main reason for giving "is a sense of concern and social responsibility for other people."
Most major religions permit the use of bodies and organs for medical science, particularly if a life can be saved. The practice, however, may run contrary to some beliefs, including some Orthodox Jews'.
The Catholic Church "considers the bequeathal of one's body to science as a formal expression of his love and concern for his fellow man . . ." says Georgetown University. "Moral leaders the world over" favor organ donations "as expressions of the highest humanitarian ideals," says the National Kidney Foundation.
About 30,000 Americans with diseased kidneys are waiting for transplants, as many as 60 to 100 of them in the Washington area. "Transplantation of a healthy kidney could return these patients to normal lives," says the kidney foundation, which estimates it has distributed more than 20 million of the Uniform Donor Cards. Gary Coleman, the young star of TV'S "Diff'rent Strokes," had a kidney transplant when he was 5 years old.
What happens when organs are donated?
A sole organ donor may supply several parts or tissues that can be used to help more than one patient. A donor's two kidneys can go to two different patients.
Some of the donor's skin may be preserved and can be used in treating victims of severe burns. It helps hold in body fluids and provides a protection against infection until the victim's own skin can be grafted in the damaged area, says GW University's Filson.
Doctors have a 90- to 95- percent success rate transplanting replacement corneas in persons who have lost vision because of an accident or infection, according to the National Institutes of Health. Annually, about 250 cornea transplants are performed in the Washington area, says Allin Robinson, executive director of the local Lions Eye Bank.
He adds that the eye bank is "constantly in need" of eyes for cornea transplants, for study of eye problems and for use by surgeons to practice their skills. The Lions Eye Bank provides its own pledge card for those who want to give only their eyes, although one can also donate with the Uniform Donor Card.
A substance from a donated pancreas can be used to treat diabetes. Like the heart and liver, bones, bone marrow and tendons also can be transplanted in some cases.
Typically, kidneys are "harvested" -- the phrase used by those in the field -- from persons who have suffered massive head injuries such as from auto accidents or gunshot wounds, or from people who have had massive strokes or brain tumors.
Their brains "are legally and medically dead," says Filson, "but the vital organs such as the lungs and the heart can be artificially maintained until the kidneys can be removed."
The situation can become sensitive at this point between the hospital and the victim's next of kin. The hospital recognizes the victim as a potential kidney source. Though the family is grief-stricken, they must be approached for their permission because the kidneys have to be removed almost immediately.
Even if the victim has signed a donor card -- which under the Uniform Anatomical Gift Act is a legal document -- the family's permission almost always is sought. If they don't agree, then the organs are not removed, says Filson, who has talked to 300 families in the past three years. He estimates that permission is denied about twice as many times as it is given. Most kidneys come from people who have not signed cards, he says.
Washington's kidney transplant hospitals are linked by computer nationally and internationally (to Europe) with an up-to-date list of who needs kidneys most urgently. A procedure to determine who gets the next available kidney is based on where the recipient lives and how likely (depending on tissue types) the body will accept it.
A Washington woman on dialysis since 1973 had to wait six years to get a proper tissue match, says Filson. "It was her lucky day."
One of the donor's kidneys may be used locally, says Filson, and the other flown elsewhere. Twice this year he has taken a kidney to the West Coast. The 40-pound, foot-square kidney transport box occupies by law a first-class airline seat at the front of the cabin. It travels at half-fare.
Kidney removals are performed with the same standards as a live surgical operation, says Filson. The eyes and other organs are removed simultaneously. The body is sewn up and can be returned to the family within hours for a funeral. The names of the donor and recipient are kept confidential. "Your wife won't know who gets your kidneys," says Filson.
Howard University transplant coordinator Curtis Yeager admits that he is troubled by one aspect of the donor program. "Ninety percent of organs transplanted in blacks come from whites," he says. "Blacks get sick too." He is working on a promotional campaign with transplant centers throughout the southeastern states to help make blacks more aware of the need for organ donations.