1. Indirect costs associated with non-heart-beating donation have to be considered as well. Required referral can be expected to increase the number of patient referrals and necessitate increased OPO resources for evaluating potential donors. Expanded donor criteria also contribute to the supply of organs as well as to the cost of organ recovery (Jacobbi et al., 1997). Concerns over these costs may deter some OPOs from participating in non-heart-beating donation.

  2. Prospective payment and managed care have a strong impact on the way in which hospital costs are allocated and covered. Third-party payers have an interest in distinguishing patient care costs from donation costs and limiting their payment obligations to the costs of patient care. The current approach (described at the workshop) of opening a new billing account when the decision to donate has been made, billing donation-related costs to this account, and auditing the bills retrospectively may not be sufficient to resolve payment questions.

  3. Further information is needed before specific recommendations can be made for paying the costs of non-heart-beating donation. Workshop participants suggested the value of a roundtable discussion among OPOs, hospitals, third-party payers (public and private), and federal agencies to review the costs of non-heart-beating donation, current payment arrangements, and possible modifications in reimbursement. Public and private reimbursement practices should not deter non-heart-beating donation.

Conclusion

Organ and tissue donation is an important option in end-of-life care. Efforts to keep this option open demonstrate respect for both patient and family wishes. Clear, comprehensive, locally developed and public protocols provide a means for organ and tissue donation to be carried out when patients die after the withdrawal of life-sustaining treatment.

Donation provides clear benefits to those in need of transplantation. The desire to benefit those in need motivates many families to request or agree to donation. However, a patient- and family-centered approach to donation emphasizes that the benefit to others is made possible only through the commitment of patients and families to salvage some benefit out of profound loss.

In a patient- and family-centered approach to donation, the compassionate care of patients and families is paramount. Such an approach treats organ and tissue donation as one among several options at the end of life. It focuses on patient and family wishes and needs. By honoring patient and family needs, it supports both the willingness of patients and families to donate and the benefits of transplantation.

Neither a protocol nor a family brochure can address all of the needs and concerns of patients and families. These needs and concerns begin with the traumatic event that leads to donation; for the family, they extend through many years of living with loss.



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