If public education is successfully intensified, however, mandated choice may prove to be unnecessary.
The current organ donation system is focused on voluntary choice: the right of the individual or the family as the surrogate to choose to donate organs after death. Preliminary data from the National Survey of Organ Donation show that Although new and innovative initiatives have recently begun to increase the rates of organ donation e.
Individuals can record their donation decisions by several mechanisms. The challenge is to ensure that the decision recorded is available to OPO and healthcare professionals, should the need arise to consider donation. For donor consent to be valid and capable of being used as an advance directive, the general public needs to be provided with accurate information about all aspects of organ transplantation; efforts should be aimed at demystifying the process and ensuring that the choice is an informed one. To date, legal or ethical standards have not been established to delineate the minimum amount of information necessary to ensure adequately informed choice.
Furthermore, disclosure of information by itself does not ensure comprehension and understanding. Later, this chapter discusses ways to enhance public education and raise public awareness. Furthermore, families who had had discussions about organ donation were more likely to agree to donate. Even if an individual has not formally taken the step of documenting his or her decision, expressing thoughts and opinions about organ transplantation with family members gives the family a basis for decision making after an unexpected death.
A major source of family information related to organ donation is the media; and studies show that media stories, which are often negative or at least ambiguous, frequently influence families not to donate Morgan et al. This finding makes family discussions about organ donation even more important.
Preliminary results from the National Survey of Organ Donation found that However, organ donation may be an uncomfortable topic for some family members: for some, it raises the specter and fear of death, and such discussions may be rapidly dismissed by family members; for others, individuals may have fundamental disagreements with their family about end-of-life decisions.
Many families, on the other hand, would engage willingly in such conversations. Clearly, as with other advance directives, these conversations are important. Rarely was it implemented as legally binding documentation DHHS, Recognizing this as a limiting factor, 43 states and the District of Columbia have enacted first-person consent donor consent laws designed to affirm the legal strength of such documentation as advance directives UNOS, a; Appendix C.
It is generally agreed that the confidentiality of donor registries is important and that access should be restricted to a need-to-know basis for relevant healthcare professionals. A culture of organ donation within a community may also be created or enhanced by publicizing the organ donation registrations of individuals who have given explicit permission for this to be done.
The goal would be to encourage others to donate by acknowledging organ donation as the accepted and practiced action of many individuals in the community. Careful study will be needed to determine whether this approach is feasible, helpful, and clearly distinct from registration efforts overall. Such elective decision making also facilitates the provision of culturally sensitive information about organ donation so that enough information is available for an individual to make an informed choice.
The decisions should be binding on others albeit easily changeable by the individual during his or her lifetime.
It is therefore important to provide multiple venues and opportunities for individuals to learn about organ donation and document their donation decisions. Furthermore, efforts are needed to ensure that donation decisions are accessible to the relevant healthcare professionals through secure online registries. More than million drivers are licensed in the United States FHWA, , and license registration and renewal thus offer the opportunity to disseminate information to large numbers of individuals.
Many states have enacted laws stating that a wallet-sized uniform donor card, signed by an individual at least 18 years of age in the presence of two adult witnesses, suffices as official documentation for organ donation DHHS, For example, in North Carolina a uniform donor card signed in the presence of witnesses provides the OPO with sufficient legal authority for organ recovery without.
As of November , 35 states had organ donor registries and others are in the legislative and administrative processes of implementing a registry UNOS, a Appendix C. This is a significant increase from the number in , when 14 state registries were identified DHHS, b. In most states the department of motor vehicles or the agency responsible for licensing drivers is the primary portal for the donor registry DHHS, a,b.
Additionally, a number of states have easily accessible websites for individual donor registration. The incorporation into donor registries of individual donation registrations and data from the department of motor vehicles and donor card registration sources thus increases the extent of coverage of the registry and the potential for the registry to be used to the greatest benefit. The principal factor limiting the effectiveness of registries is that only small numbers of people are currently registered.
However, many of the state registries have come into existence only in the past 5 years, and the cumulative effect of ongoing registrations and the long-term benefits of increasing the rates of organ donation will be seen only when they are tracked over time. Beasley and colleagues modeled the cost of organ donor registries and estimated that when the incremental benefit of donor registries above and beyond current donor strategies is considered, 83, registrations would be required to realize one potential new donor within a year.
en.funurusywo.gq In a more recent analysis, Howard and Byrne in press examined the value of donor registries based on the lifetime probability of becoming an organ donor. The committee could not locate data on the current costs of implementing and maintaining a donor registry, but because many states use existing online systems e. The advantage of an online registry system is that opportunities to register to donate can be presented in multiple locations. Furthermore, registration sites can be used for public education efforts DHHS, b.
A study in Arizona indicated that people were interested in the availability of organ donor registration opportunities at healthcare facilities, places of worship, and departments of motor vehicles, as well as at kiosks that could be set up at special events or shopping areas Siegel et al.
Access to donor registries must be available only to appropriate medical and OPO personnel, and all entries in the database must be tracked and validated. Furthermore, it is important to ensure that the information residing in the registry remains accurate. Challenges arise in updating the registries with current information on individuals who have died or who have moved out of the state DHHS, a. Missouri has developed a useful program to address this concern and uses robust software that compares the organ donor registry with registries of deaths in the state on a regular basis personal communication, L.
It is important to acknowledge that donor registration is not the primary mission of the department of motor vehicles; accordingly, collaborative efforts and funding that support the training of department of motor vehicles staff and that provide educational materials on organ donation are important and should be strengthened.
Providing multiple means of registration e. Considering the mobility of the U. Action is needed at the federal and state levels to follow up on earlier efforts to examine donor registries DHHS, , a,b and determine the optimum system for coordination. Other occasions offer additional opportunities to provide information on organ donation and to document donation decisions.
End-of-life healthcare planning provides individuals with the opportunity to explicitly express their decisions on a range of healthcare options. Although this goal has not yet been fully achieved, systems are currently in place to support those who choose to exercise this opportunity.
Routine inquiries about advance directives and preferences for organ donation upon admission to the hospital Essebag et al. For this to be a viable option, however, all patients would need to have access to primary healthcare practitioners who are skilled and knowledgeable about basic palliative care therapies and the option for organ donation.
Nevertheless, such an inquiry can be appropriate if made with sensitivity. A key factor in increasing rates of organ donation in the United States is a knowledgeable citizenry. Having the information necessary to make informed choices is essential and is the basis of individual autonomy. Public education regarding organ donation is an area of considerable activity. A number of nonprofit organizations are active in this area, including the Coalition on Donation and its state and regional coalitions Box ; the National Kidney Foundation and its state and regional affiliates, which sponsor many public education and donor awareness programs, including the U.
Transplant Games; the Eye Bank Association of America affiliates; the Nicholas Green Foundation, which provides videos for public education; and the numerous chapters of recipient and donor family volunteer groups, such as the Transplant Recipients International Organization and national and local Donor Family Councils. OPOs have a mandate to promote public education, and they are actively involved in offering a wide range of educational programs.
Many faith-based organizations are active in promoting Donor Sabbath, a day focused on celebrating organ donors and encouraging donor registration.
Data analysis The data were analyzed using the conventional content analysis method. The collaboration and linkages between state department of motor vehicles offices and the transplantation and healthcare communities have played important roles in increasing the numbers of registrants in donor registries and in providing an avenue for public education regarding donation. Medicine, Health Care, and Philosophy. International practices of organ donation. Bursztajn's article regarding the increasing scrutiny the courts are giving to the process as well as the content of medical decision making—not only what the decision was, but who made it and how it was made. The mandated-choice model would require each adult to make an explicit choice and would offer a routine, uniform, and systematic means of collection of and access to data on donation preferences Dennis et al. This article has been cited by other articles in PMC.
The insights provided by individuals who are transplant recipients or family members of donors are particularly valuable in depicting the personal realities of the impact of donation decisions. The Coalition on Donation, founded in , is a nonprofit alliance of organizations and local coalitions across the United States that works to educate the public about organ, eye, and tissue donation. The Coalition is made up of 47 local coalitions that cover 95 percent of the U.
These local groups play an important role in disseminating organ donation materials. Coalition on Donation members meet regularly to share strategies, discuss best practices, and find solutions to common problems in boosting organ donation awareness and consent. They also work to develop effective relationships with local television, radio, and newspaper media in their production of human interest stories and often connect local transplant recipients or donor families with local media.
The federal government also funds projects to increase public awareness and promote public education. Donate Life is the ongoing campaign used nationally by the Coalition on Donation www. However, myths, misinformation, and uncertainties about organ donation and transplantation continue to abound. Actively engaging the general public to focus attention on a public health issue is a challenge faced in connection with a broad range of public health concerns.
Public education has been an important tool in such public health successes as motor vehicle safety, childhood vaccinations, and safer workplaces. A review of the 10 greatest public health achievements of the 20th century found that mass media, school-based. Many myths about organ donation and transplantation have arisen. It is important to correct these myths and misperceptions in media and educational descriptions.
Fact: If you are sick or injured and admitted to the hospital, the number one priority is to save your life. Organ donation can be considered only after death has been declared by a physician. Fact: When you are on a waiting list for a donor organ, what really counts is the severity of your illness, the time that you have spent waiting, your blood type, and other important medical information. To ensure that your family understands your wishes, it is important that you tell your family about your decision to donate life.