Organ donation

New York's experiment in organ donation is intriguing:

with a $1.5 million grant over three years from the federal Health Resources and Services Administration, a team of medical experts and bioethicists is looking to expand the city’s donor pool by deploying a “rapid organ-recovery ambulance” to collect and preserve the organs of people who die of cardiac arrest. The plan — modeled on a successful program in Spain — is for the ambulance to trail regular ambulances that try to save people’s lives, then to swoop in if patients die and to maintain the bodies in stasis for several hours at a hospital, until family members can decide whether to donate the organs. …

New York’s recovery ambulance is inspired by a donor-detection program started in 1989 in Spain, which now has the highest organ-donation rate in the world. In the past two decades, Spain has tripled organ donation to 35 donors per million people, significantly shrinking its waiting list. In the United States, there were 23 donors per million people in 2007, according to the organization Donate Life America, with roughly 99,000 people waiting.

The article also quotes project leader Dr. Lewis R. Goldfrank, director of emergency medicine at Bellevue Hospital Center, who explains his motivation: "To see people die every year who are waiting on organ-donor lists and people die who are potential donors, seems a mismatch between societal needs and societal values."

The transition in Spain is not just a result of a different ambulance. Spanish law was changed so that people were organ donors by default, but could opt not to be organ donors if they chose. As it stands now, you can only be an organ donor if a family member agrees to the surgery. Checking off the box on your driver's license is a helpful hint to your family, but is not legally binding. The only way to ensure that doctors can use your organs to save other lives after you die is to talk to your family and friends so that they know what you want done. My family all know that I want doctors to use whatever they can. Now's as good a time as any to let your families know what you'd like. And be sure to talk about this regularly, since opinions change.

That conversation is also a good time to figure out what you want to happen if you are in a coma or otherwise on life support. Clear instructions and discussions with family are the only way to avoid a situation like Terry Schiavo's a few years back. And only by talking about these issues before they are imminent can we as a society move to a more nuance approach to these tricky issues.