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The physician's role in discussing organ donation with families
Michael A Williams1, Pamela A Lipsett, Cynda H Rushton
1Johns Hopkins Medical Institutions, Department of Neurology, Johns Hopkins University Bioethics Institute, Baltimore, MD, USA.
Insights
Physicians can be involved in organ donation discussions with families. Proper training ensures physicians can effectively support end-of-life care and organ donation decisions.
Area of Science:
- Medical Ethics
- Transplantation Medicine
- End-of-Life Care
Background:
- Federal regulations mandate offering organ and tissue donation options to families.
- Physician involvement in organ donation processes has been a point of discussion.
- The demand for transplantable organs exceeds the current supply.
Purpose of the Study:
- To review federal Conditions of Participation regarding physician involvement in organ donation.
- To clarify the role of physicians in end-of-life care and organ donation discussions.
- To address the variability in physician and nursing skills for end-of-life decision-making.
Main Methods:
- Review of federal regulations (Conditions of Participation).
- Analysis of the American Medical Association's resolution on physician involvement.
- Discussion of end-of-life care practices in intensive care units.
Main Results:
- Federal Conditions of Participation do not prohibit trained physician involvement in organ donation requests.
- Physician and nursing knowledge, skills, and attitudes for end-of-life care vary widely.
- Family experiences significantly influence organ donation decisions.
Conclusions:
- Physicians play a crucial role in supporting families through end-of-life decisions and organ donation.
- Training is essential for healthcare professionals involved in organ donation requests.
- Collaboration with organ procurement organizations enhances patient and family care.
Abstract:
Federal Conditions of Participation from the Health Care Financing Administration (now the Centers for Medicare and Medicaid Services) introduced in 1998 require that all families be presented the option of organ and tissue donation when death is imminent. The perception that physicians were being excluded from participating in this process led to a resolution at the American Medical Association House of Delegates meeting in December 1999, calling on the American Medical Association Council on Scientific Affairs to review the Conditions of Participation "to ensure that there is no prohibition of physician involvement in the organ donation process..." The number of organs procured for transplantation in the United States is insufficient to meet needs. Families' hospital experiences significantly affect their decisions to donate organs. Discussing severe brain injury, brain death, and organ donation after brain death with families is a specialized form of end-of-life decision-making and care in the intensive care unit; however, the knowledge, skills, and attitudes necessary for physicians and nurses to promote good end-of-life decision-making are widely variable. The federal Conditions of Participation require that those making requests of families for organ donation receive specific training. They do not prohibit physician involvement in initiating organ donation requests, provided these individuals are properly trained. Physicians have an important role in caring for patients and families in these circumstances, and the care they provide is enhanced through training, attention to the special issues involved, and collaboration with organ procurement organization personnel.