Organ donation and transplant is all about timing. The organs have to be harvested quickly to remain viable and must be transplanted within hours to increase the likelihood that the new organ will take.
One of the most controversial aspects of the donation-time equation is choosing when to discuss donation with a potential donor’s family. Should discussions begin when brain death is deemed inevitable, or should they wait until neurological tests can confirm brain death?
From a medical perspective, the sooner discussions and arrangements for donation occur, the more likely the transplant will succeed. From a psychological standpoint, talking to family members about organ donation too soon could unnecessarily upset them and, according to research from the Netherlands published Thursday, make them less willing to go through with donation.
In the specific Netherlands hospital studied, researchers found that before 1998 organ donation was not discussed with the family until all neurological tests had confirmed brain death. After 1998, discussions began a little earlier, after the loss of consciousness and brain stem reflexes but before confirmatory neurological tests.
They found that when discussions began early, the number of families opting for organ donation dropped from 89 percent through most of the 1990s to 58 percent between 1998 to 2009.
While it is impossible to say whether the timing of the discussion played into the decline in families opting for donation, the research raises a difficult question: How can these discussions be timed to minimize the family’s discomfort while maximizing the chance that the organs can be harvested early enough for the transplant to succeed?
This question came up in September, when the United Network for Organ Sharing updated its guidelines to suggest that hospitals and organ donation organizations begin discussing the possibility of donation before raising it with the patient’s family. This change was intended to expedite the donation process when donation is possible and spare the family needless donation discussions in cases when it is not.
This change stirred controversy, however, because it requires donation discussions to begin, even if only among medical professionals, before the family has made the decision to withdraw life support.
Even if it makes it more likely that organ donation would succeed, broaching the idea before the patient has died remains a touchy topic, and it could scare some donors away, Dr. Michael Grodin, a professor of health law, bioethics and human rights at Boston University, told ABC News last September. He said he worried that any loosening of regulations surrounding organ donation could break down the “absolute trust” that must exist between donor families and doctors.
“Better to have fewer transplants and absolute trust in the system, or not only will there be individual problems, but this could actually lead to fewer families willing to donate,” he said.
At the same time, waiting too long to have the discussion may mean that “sometimes [it] is not logistically possible for donation to occur,” Dr. Jeffrey Punch, chief of the section of transplantation at the University of Michigan’s Department of Surgery countered. “This is tragic for that family, [because often] they desperately want their loved one’s last function on earth to be saving other’s lives, as well as to the recipients that do not benefit.”