Many of Maryland's 17,000 physicians soon will begin approaching their patients to discuss something that has long been a taboo subject in doctors' offices: becoming an organ donor.
Maryland's medical society, along with the state's two organ procurement agencies, yesterday began pushing physicians to become de facto lobbyists in their drive to increase the state's number of declared organ donors from about 1.2 million to more than 1.8 million.
Doctors are being encouraged to use their time with patients to make personal pleas for them to become organ donors, to give them brochures explaining donations and to set an example for the patients by filling out organ donor cards themselves.
The society is the third state doctors group--after those in Texas and Minnesota--to join an effort to increase the supply of donor organs for the 65,000 Americans on transplant waiting lists. On the average day, an estimated 12 people on the lists die, still waiting for suitable donors to be found.
Livers and kidneys are in particular demand, but the initiative is aimed at harvesting all types of organs and tissue. The need for organs is particularly acute in Maryland, which has 2,300 people on its waiting lists.
The focus of the Maryland campaign is not simply to persuade patients to sign pledge cards and carry them in their wallets. The most important element is discussing the matter with families, who then have enough information to carry out the donor's wishes after he or she becomes incapacitated.
Even in the case of a declared donor, organs will not be harvested without the family's permission.
The initiative could represent a challenge for doctors who have been reluctant to alarm patients with a discussion of how their organs could be used after they die.
Angus Winston McLaurin, 71, who recently retired after 42 years as an internist in Hyattsville, said doctors have to be cautious in raising the subject with patients.
"You have to know them awfully well and then get an indication of how they would feel about it by asking indirect questions," he said. "If you get the feeling they're totally against it for religious or personal reasons, I'd steer clear."
McLaurin said some doctors will remain opposed to getting involved in organ donations.
"I doubt there is any open resistance," he said, but "some might say that's the patient's business; let them decide. But the physician can give some encouragement, and if you have a good rapport with the patient, maybe you can push him over the edge."
Christopher C. Dunford, 45, a Rockville internist, said he does not believe that younger doctors will have a problem with lobbying patients to become donors because transplants have been common during their adult lives.
"I don't see a whole lot of resistance" among physicians, he said. "I know my partner wouldn't mind."
Brian A. Hartford, a Howard County General Hospital chaplain, said having physicians lobby patients for organs is a huge turnaround even from 1990, when he received a heart transplant at Washington Hospital Center.
"Just the fact of that brochure is a big step," Hartford said. Many doctors are "just afraid to have something like that in their office. It's hard for a lot of people to make a stand."
Although the public has grown far more receptive to transplantation, the lobbying campaign isn't without risks.
Some patients could be turned off by doctors' taking a blunt approach. Many doctors remain reluctant to raise the issue at all and have declined to display organ donation brochures that explain the process.
"If I just came in for a routine exam and was approached by my doctor, I would probably be taken a little off guard," said Dawn Rundhammer, 41, a substitute teacher from Rockville. "I think it would surprise me. I think as you get older you're probably a little more standoffish, and thinking, 'So, does the doctor think I'm going to die?' "
Yet Rundhammer and other patients say the benefit of increasing the donor organ supply should trump those attitudes.
"I think it's perfectly in order," said Eleanor L. Hughes, 71, a retired schoolteacher from Silver Spring who yesterday visited her Gaithersburg internist, Michael A. Greene. She has been a declared organ donor for years and sees nothing wrong with doctors' approaching patients about it.
"We need healthy organs," she said, adding that her family knows her wishes. "They all know what to do. Anything of mine that's healthy, they can have."