Should we be more aggressive in honoring a donor's wishes?

UNOS reported that the number of cadaveric organs procured in 1997 was 5,429, virtually unchanged from the previous year. Meanwhile, the number of patients waiting for an organ transplant, the majority of them dialysis patients, has topped 50,000. How do we make up for the disparity in demand versus the supply? The Department of Health and Human Services has announced a new initiative to increase donation by 20%. And a new HCFA regulation now requires hospitals to report all deaths to its designated organ procurement organization in an effort to identify more potential organ donors. The method has proven successful in improving organ procurement in two states already. But studies have shown that improving organ donation has more deep-seated obstacles: a public that supports organ donation in surveys and polls but may not carry through on the actual donation when a loved one is a potential candidate, and a medical staff that is not trained or remains uncomfortable with asking families to donate at a time of grieving. Should we simplify the process and institute presumed consent laws or strengthen the legal utility of the organ donor card? In this section, dialysis patient Theodore Latour, now awaiting a donor kidney, suggests we take a more aggressive approach resembling presumed consent. Two transplant coordinators--Alesha Sinclair, RN, CCTC, and Pete Walczak, RN, CCTC--offer a response to his views.