What Role Do Trauma Physicians Play in Facilitating Organ Donations?

With the current organ shortage, there have been many discussions about ways to encourage organ donation. One option that is up for debate is the idea of treating severely injured trauma patients for the purpose of elucidating their preferences for organ donation. An article published in the AMA Journal of Ethics¹ discussed the topic. The authors examined the role of trauma physicians as well as guidelines and ethics that are in place to guide clinicians to decisions about treating patients while considering the current need for organ donation.

According to the study, the American Medical Association Code of Medical Ethics states in their guidelines for organ transplantation that “the physician’s primary concern must be the well-being of the patient.” Although organ donation is important and is considered a public good, trauma physicians are charged first and foremost with restoring and maintaining the health of their patients. Clinical ethics require that patients be treated with any life-saving means possible until declared brain dead or at risk for imminent death. For a team caring for a trauma patient, this means making care decisions based on both the state of the patient and the patient’s injuries.

Federal regulations indicate that “[n]o physician or nurse or any other caregiver in the hospital is allowed to make decisions about patient medical sustainability for any type of organ, tissue, or eye donation.” Instead, clinicians must rely on federally designated organ procurement organizations (OPOs) to assist with those steps. The OPO will communicate with the patient’s family to inform them about organ donation and take their preferences into account. In the case of a patient having given authorization for donation, the OPO will inform the family of the patient’s decision. Research has shown that family members of patients who spent more time with OPO staff were more likely to agree to organ donation.² Similarly, public education and outreach by physicians, as well as education of both emergency and trauma physicians, has led to an overall increase in organ donation.

Ultimately, the ethical responsibility of trauma physicians is to respect the patient’s right to life with regard to making treatment decisions. Although organ donation is a public good and is increasingly important considering the current organ shortage, there are ethical guidelines physicians must follow for donation to occur. Efforts such as educating the public and allowing both physicians and OPOs to operate separately according to established systems can prevent ethical tensions while facilitating donation.

References

1. DiBrito SR, Henderson ML. Should trauma physicians treat a severely injured patient for the sake of elucidating preferences about organ donation? AMA J Ethics. 2018;20(5):447-454.
2. Siminoff LA, Gordon N, Hewlett J, Arnold RM. Factors influencing families’ consent for donation of solid organs for transplantation. JAMA. 2001;286(1):71-77.