A change to the U.S. organ transplant system will allow organ procurement teams to speak with families before they have decided to discontinue a loved one's care. The policy, which takes effect in November, is intended to improve patient safety and preserve opportunities for donation, but critics fear it could leave families feeling pressured.
The Organ Procurement and Transplantation Network, which runs the nation's organ system, is easing a longstanding restriction separating donation discussions from decisions about ending care. Under the existing rule, representatives of the organ system are supposed to wait until a family has made that decision. The new guidelines permit conversations once families begin considering it.
Dr. Lainie Ross, a University of Rochester bioethicist, said that separation helps ensure that the patient remains the focus of hospital care. It also protects families from questioning whether recommendations to withdraw treatment reflect their loved one's condition or the needs of people awaiting organs. Ross said consideration of whether organs can be used should follow a determination that death is inevitable and imminent.
Dr. Raymond Lynch, director of transplantation at the Health Resources and Services Administration, the federal agency overseeing the organ system, defended the change. He said a firm boundary alone offers insufficient protection without attention to what happens before and after it. The revised approach is part of a larger effort to improve communication among organ procurement organizations, hospital care teams and patients' families.
That broader package responds to serious past mistakes, including cases in which patients were taken to operating rooms for organ removal while still alive. The new policies make it easier to halt organ retrieval when someone raises concerns and establish consistent patient protections, including testing used to determine death.
Lynch said safety depends on clear documentation, coordination, respect for the primary healthcare team's role and consequences. He described the combined changes as an improvement over the previous policy, with the earlier discussions forming one part of that effort.
Officials also want to prevent procurement teams from becoming involved too late to carry out a patient's wish to donate. Lynch said missed donation opportunities deprive patients of their chosen outcome, families of a meaningful memory and people on transplant waiting lists of a chance to receive a lifesaving organ.
Critics remain concerned that earlier involvement could encourage families and caregivers to end treatment sooner or blur the distinction between those caring for a patient and those seeking organs. Ross warned that families could feel manipulated and lose confidence that doctors are acting for their loved one. She called the change “a really serious and really bad move.”
