The Organ Procurement and Transplantation Network made two changes to transplant rules aimed at improving communication and safety, but critics say they may raise ethical and patient care issues, NPR reported Oct. 28.
On Aug. 20, the OPTN board of directors voted to modify two rules as part of a new set of guidelines governing donation after circulatory death. The changes allow “discussions for organ donation to take place once end-of-life discussions are taking place with the potential deceased donor’s agent;” make it easier to pause organ retrieval if anyone raises a concern; and standardizing other patient protections such as testing for determining death. The rules take effect Nov. 18.
Previously, no one was supposed to talk to family members about organ donation until they decided to withdraw life support for a loved one. That rule was intended to prevent pressure that could change the care patients receive.
The policy changes are designed to ensure the organ retrieval team isn’t brought in too late to conduct tests and necessary preparations, while also preventing mistakes that have occurred in the past, such as patients being taken to operating rooms for organ removal while they were still alive, the report said.
“I think the best way to think about [the policy change] is that insisting on a bright line without focusing on what’s happening on either side of that line is a false sense of security,” Raymond Lynch, MD, the director of transplantation at the Health Resources and Services Administration, the federal agency that oversees the organ network, told NPR. “That specific line in the policy is part of a suite of improvements to the coordination and communication between the organ procurement organizations and the healthcare team that is caring for these patients in hospitals and the families of the patients themselves. And that really is a marked improvement over the policy that was in place before.”
Critics told NPR the changes could subtly pressure families to discontinue care and create confusion about who is there to save the patient’s life and who is there to obtain their organs.
“It’s a very important bright line,” Lainie Ross, MD, PhD, a bioethicist at the University of Rochester, told NPR. “Our primary responsibility is that patient’s well-being and care. And we need a bright line. That’s where our focus is, and we’re not even going to start thinking about whether those organs are usable until death is inevitable and imminent.”
Critics also said the changes could interfere with the families’ grieving and weaken patient safeguards.
However, the Association of Organ Procurement Organizations supported the changes in public comments on the proposal.
“Families/agents who are considering [withdrawing life support] must be informed about donation and how the donor evaluation process may affect the timing of the [withdrawal of life support],” the group said in its public comments. “Many families have expressed frustration with learning about this timing impact after planning for other family members to be present at the time of [withdrawing life support]. Waiting until the family has made the decision is too late.”
Becker’s 3rd Annual Fall Chief Pharmacy Officer Summit is the top tier event that the people leading the future of pharmacy convene. This 3-day event is built specifically for Chief Pharmacy Officers and senior pharmacy leaders. The sessions examine the workforce, financial and clinical priorities shaping pharmacy today. Becker’s is where candid discussions flourish and new ideas thrive. Becker's 3rd Annual Fall Chief Pharmacy Officer Summit
