Does the Revised Uniform Anatomical Gift Act Still Take Care of Organs before Patients?

IN RESPONSE:

We thank Dr. Verheijde and colleagues for their comments. We agree that the revised act remains imperfect and contentious. The original Sections 14(c) and 21(b) required provision of critical care procedures and support to maintain the potential for organ donation. The National Conference of Commissioners on Uniform State Laws (NCCUSL) was trying to discourage clinicians from hastily discontinuing life-sustaining treatments before the potential for organ donation could be assessed. The NCCUSL argued that most Americans want to become organ donors after death, and therefore care alteration that prevents that option precludes the will of the majority. They purport to have data showing that many persons who might become brain dead have life-sustaining treatment stopped before assessment of donor status.

In its efforts to prevent failure to procure organs from persons desiring to donate, the NCCUSL effectively prevented another shared will of U.S. citizens, namely to have control over their end-of-life care. When we spoke directly with NCCUSL about this issue, they agreed that the act allowed donation to trump other end-of-life care considerations, including advance directives and family wishes. They subsequently made changes. Section 21(b) now recognizes that organ donation consideration is one part of end-of-life care and states clearly that organ donation should not interfere with quality end-of-life care. The NCCUSL reasoned that adjustment to section 14(c) was moot, because Section 21 now makes these points. We feel the changes establish equipoise between donation and end-of-life care and therefore warrant our support.

We believe Dr. Verheijde and colleagues' second assertion is simply wrong. Multiprofessional, governmental, and ethical groups have provided support (1). We also disagree with Dr. Verheijde and colleagues regarding the proper balance between respecting wishes about end-of-life care and organ donation. We support both organ donation and quality end-of-life care. Some may see organ donation and end-of-life care as mutually exclusive considerations, but that is not usually the case. With thoughtful discussion, it may be possible to accommodate both. With permission, briefly continuing life support to enable organ donation may allow an important end-of-life goal to be achieved.

Finally, we believe future work on the Uniform Anatomical Gift Act should include end-of-life care professionals because transplant recipients are not the only constituency that needs to be represented in their deliberations.