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Tuesday, November 15, 2011

"Donor dead yet?"--CMA physicians challenge imminent organ transplant policy changes


Washington, DC--November 14, 2011--The 16,000 member Christian Medical Association (CMA) urged a "no" vote today on proposed changes in the ethical standards the government endorses to guide organ transplants, contending that the changes would weaken ethical boundaries and could endanger patients, open the door to abusive practices by healthcare facilities and force conscientious professionals out of medicine.
CMA CEO Dr. David Stevens conveyed the warning in a letter sent today to John R. Lake, M.D., President, Board of Directors of the Organ Procurement and Transplantation Network (OPTN) in Richmond, Va.
The OPTN board is considering the policy change today and tomorrow. OPTN recently proposed changes to the Donation after Cardiac Death (DCD) Model Elements. The proposed new, mandatory policy is designed to guide procedures in securing organs from patients immediately after death--the very definition of which has engendered controversy.
CMA's letter noted, "The removal of the requirement of 'irreversibility' of cardiopulmonary cessation exposes patients to potential exploitation. CMA is concerned that relaxing the definition of death would considerably increase the risk that procedures to remove vital organs would be performed on some patients lacking unambiguous signs that death has occurred. CMA is also concerned about the impact that publicized abuses of the new policy could have on the public’s trust in transplant medicine and their willingness to volunteer as future organ donors."
CMA also noted, "The proposed Requirements remove the important stipulation separating patient care from donation solicitations. Whereas previously the hospital’s primary healthcare team and the legal next of kin must have decided to withdraw ventilated support or other life-sustaining treatment before the patient is evaluated as a DCD candidate, under the proposed policy a patient may be evaluated as a DCD candidate prior to a decision by family members and caregivers, which ought to be free from external pressure. Gone is the crucial wall separating patient care from donation solicitations. Such undue influence on difficult decisions at a heart-wrenching time is ethically unacceptable."
CMA further observed, "The proposed Requirements broaden donor criteria to include patients without cognitive neurological injury. As physicians, we are greatly concerned that patients with chronic illnesses such as spinal cord injury or amyotrophic lateral sclerosis (ALS) would be vulnerable to real or perceived pressure to decline further treatment in order to donate their organs…"
CMA concluded, "The unintended consequences of the proposed Requirements would be antithetical to the ethical practice of medicine. By loosening previous stricter guidelines, by eliminating vital safeguards and by failing to clarify key criteria, the proposed Requirements signal that hospitals and healthcare professionals can now relax ethical concerns and safeguards in favor of pursuing a utilitarian 'higher good' of obtaining a greater number of organs for transplant. We believe that such a change in emphasis, however subtle, would erode the ethical practice of medicine by promoting a culture of utilitarianism or casualness regarding life and death decisions.
"If physicians conscientiously opposed to such policies were forced to retire from the practice of critical care medicine rather than participate in them, society would lose many dedicated, skilled and compassionate caregivers."
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