amendment of UAGA in 1987 assigned explicit priority to the donor’s intent even if his or her family objected to donation. In several states, the individual’s decision to donate is recorded on an organ donor card, on the individual’s driver’s license, or in a donor registry and is as legally binding as an advance directive regarding end-of-life care (DHHS, 2000). In practice, however, organ donation and recovery involve a complex set of circumstances and decisions.

When the individual’s wishes regarding donation are not known, discussions between the family of the deceased individual and the OPO and hospital staff focus on the opportunity for donation and the family is asked to make a decision about donation. Families often view organ donation as a way to redeem an otherwise tragic situation; as a way to honor their loved one’s life, passions, and philosophies; and as a way to help others live. Despite such positive reasons to consider organ donation, historically only 50 percent of families asked to consent to organ donation do so (JCAHO, 2004). However, progress has been made both in identifying dying patients who would be potentially suitable donors and in obtaining family consent for donation. Gortmaker and colleagues (1998), examining 1990 data, found that 27 percent of eligible patients had not been identified as potential donors or the family had not been contacted. The study found that 48 percent of the families who were asked to donate their loved one’s organs consented to the donation and that 33 percent of the deceased persons who were potential donors became actual donors. This contrasts with data collected between 1997 and 1999 by Sheehy and colleagues (2003), who found that only 16 percent of eligible patients were not identified as potential donors. Results from the latter study showed that 54 percent of the families who were asked to donate consented and that 42 percent of the potential donors became actual donors. These results suggest substantial improvements over the course of the decade, and consent rates have continued to improve in recent years. The process of organ donation is outlined in Figure 1-3.

It is difficult to determine the uppermost potential for the number of deceased organ donors. Efforts to date have focused on estimating the number of potential deceased organ donors with neurologic determination of death. However, the potential pool also includes a large number of individuals whose deaths are determined by circulatory criteria, although estimating the number of such potential donors is a complex task (see Chapter 5).

Guadagnoli and colleagues (2003) estimated the number of potential deceased organ donors (neurologic determination of death) in the United States in 1998 to be 16,796; the actual number of deceased donors in 1998 was 5,793. This analysis used hospital case-mix data, hospital bed size, medical school affiliation, and status as a trauma center to estimate the

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