and may be important in the future if supply is to grow. In spite of their cited problems, results of procurement and transplantation of organs from NHBDs apparently can be competitive with those of more ideal donors. It can be concluded, therefore, that the recovery of organs from NHBDs is an important, medically effective and ethically acceptable approach to closing the gap that exists now and will exist in the future between the demand for and the available supply of organs for transplantation.

There is an important message that emerges, in addition, from an extended consideration of the premises, information, and conclusions presented in this report. Organ donation provides an opportunity to restore vital organ function and reduce morbidity and mortality which is of significant societal value. The public, professionals, hospitals, third-party payers, and government should all further the effort to improve levels of organ donation, including more widespread use of donor cards, a greater investment in support of donation, exploration and implementation of more effective procurement methods, enhanced public awareness, and other steps. This effort to provide this value is the context within which policies and procedures of the national transplantation effort are considered, and it is this value, along with the discouraging prospects for major and sufficient increases in donor supply from living and heart-beating donors, that encourages efforts to realize new kinds of donors such as NHBDs.

There are concepts or principles that should be included in the general context. For purposes of the survey described in this report, the IOM, as is common in survey reports, observed individual OPO confidentiality. Nevertheless, the principle should be that OPO policies and protocols are publicly available. Donor families stress that openness and the involvement and approval of interested members of the public are important in protocol development, in OPO governance and transplant program operation, in donor recruitment, and in other public education efforts. Such efforts, carried out through informational material, public advisory groups and boards, and educational campaigns can enhance public trust and support of organ donation and transplantation (Coolican, 1997). Furthermore, because organ donation and transplantation are so closely and intimately related to matters of life and death, meticulous attention should be paid to ethical considerations. Explicit assurance of this attention and a solid ethical foundation for whatever is done in donation and transplantation are the other important elements in public trust and support. This report has identified informed consent, not killing in retrieving organs, respect for donor and family wishes, and prohibition of active euthanasia as among the principles that are important to this ethical foundation. There may also be times when more conservative approaches than those which some might find ethically permissible should be taken in deference to the current state of public perspective and opinion.

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