I have been working in transplantation for several years now and we are always grateful for the donors and their family.   Without them some people could not be given a second chance at life.  As a transplant professional there is nothing better than seeing the progression of a patient from when they first come to the office for consultation all the way to 3-6 months after the organ transplant.  They go from being the sickest and hopeless they personally have been to finally receiving hope and then being the most grateful people around with their improved quality of life.  The after transplant quality of life that the transplant recipients experience make it all worth the hard work to get there. 

                A few years ago I did sign my organ donation card thinking it was more of a way to notify my loved ones of my wishes if I ever become brain dead than what it actually is; a legally binding contract.  People in my family also signed it because we all believe in the cause.  Why not help others in need with good functioning heart, liver, lungs and kidneys  if my brain is dead?  This seems to be a no-brainer.  This was until I really found out about the real meaning of “signing your card”.

                The Uniform Anatomical Gift Act (UAGA)was first passed by Congress in 1968 but was revised in 1987.  The revision was made to address one specific need:  many organs were not used for transplants due to family not consenting on behalf on their loved one.  In a way, the 1987 UAGA revision makes it now “illegal” to request consent to the next of kin for organ recovery.  If a brain dead patient had signed its card, the organs can be used for transplant without asking anybody’s permission.  Not even the spouse or the mother.   It also provides immunity to the medical professionals in the event they use the organs without the family consent despite the donor card signature as long as it was done in good faith. 

                The law has no penalty attached to it in case of violation so it is mostly used as a guideline but does offer real protection against a lawsuit for the medical professionals.  Every state has adopted a slightly different version of the law.  Some simply require a box to be checked at drivers license renewal time while other states require 2 witnesses to the potential organ donor signature. 

                How is this law applied in the real world??

                Most organ procurement organizations (OPO) will still go for the donor family’s permission to recover the organs for transplant whether or not the card was signed.  The rest of the OPOs will not obtained consent from the family in cases where the donor had signed the card and the family refuses donation.  They will use the organs as the law allow them to do it.  Most OPO and the whole transplant world would not want to see such a potential PR nightmare(going against the family’s wishes)  and have it “advertized” on national TV.  That would be bad publicity.  This is why most OPO will still obtain the next of kin’s consent. 

                I have not done a poll to test people’s knowledge about the significance of signing the card but I am sure there is a good portion of volunteer donors who don’t really know the full implication.  I did not know at the time, I found out later.  I realized my wife may not have control on when to let me go should I be diagnosed brain dead.  My wife knows my wishes of wanting to be an organ donor but I want her to be able to make the decision if that time comes.  So, I unsigned my card to give back the power to my family instead of the government. 

P.S. In no way am I suggesting different quality of care for a potential organ donor and non-donor after a  tragic event.  It is more about retaining control of the decision by the family.  OPO and governments should better communicate the full implication of signing the card and potential donors should also talk with their family to express their wishes. 

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