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The U.S. organ transplant system is making a big change to a longstanding rule designed to protect potential donors. The change is designed to improve patient safety and the chances that patients can donate their organs. But as NPR health correspondent Rob Stein reports, critics worry about unintended effects.
ROB STEIN, BYLINE: There's long been a strict firewall between the doctors trying to save a patient in a hospital and the transplantation team standing by to procure their organs. No one from the organ system is even supposed to talk to family members until after that heart-wrenching decision to discontinue care.
LAINIE ROSS: It's a very important bright line.
STEIN: Dr. Lainie Ross is a bioethicist at the University of Rochester.
ROSS: Our primary responsibility when a person walks into a hospital is that patient's well-being and care. And we need a bright line that that's where our focus is, and we're not even going to start thinking about whether those organs are usable until after there's a decision that death is inevitable and imminent.
STEIN: To prevent pressuring anyone and guard against any doubt that doctors are trying to do everything they can to save, say, their mom.
ROSS: When my family member is in that hospital bed, I want to know that we're all on team mom and not looking out for the next set of patients. And if you decide to withdraw, now you're also worried 'cause you're not sure if the reasons the docs are really suggesting that the treatments aren't working is 'cause they want your organs for someone else.
STEIN: But the Organ Procurement and Transplantation Network, which runs the nation's organ system, is relaxing that rule. Under new guidelines, organ procurement teams will soon be authorized to talk with families as soon as they start considering letting go. Dr. Raymond Lynch is the director of transplantation at the Health Resources and Services Administration, the federal agency that oversees the organ system.
RAYMOND LYNCH: I think the best way to think about it is that insisting on a bright line without focusing on what's happening on either side of that line in time, that really just is a false sense of security.
STEIN: The change is part of a broader set of new policies designed to prevent disturbing mistakes that have occurred in the past, like patients being wheeled into the operating room to remove their organs when they were still alive.
LYNCH: That specific line in the policy is part of, really, a suite of improvements to the coordination and communication between OPOs, the organ procurement organizations, and the primary healthcare team that is caring for these patients in hospitals and the families of the patients themselves. And that really is a marked improvement over the policy that was in place before.
STEIN: The new policies also make it easier to pause organ retrieval if anyone becomes alarmed that something's amiss and standardize other patient protections, including testing for determining death.
LYNCH: Documentation, clear coordination, deference to the primary healthcare team and consequences - that's what keeps patients safe.
STEIN: The changes are also designed to make sure the organ retrieval team isn't brought in too late for families to honor their loved one's desire to be a donor.
LYNCH: And the family loses out on that memory. The patient loses out on the choice that they made, and individuals on the waiting list lose out on the chance to receive a lifesaving organ.
STEIN: Critics, however, say the change is dangerous. It could pressure families and caregivers to discontinue care sooner and create confusion about who's trying to save their loved one and who's there to obtain their organs. Here's Dr. Lainie Ross again, the University of Rochester bioethicist.
ROSS: I think it's actually a really serious and really bad move. I'm horrified to think that families will feel pressured. They'll feel manipulated. They'll feel distrustful - that the docs are looking out for some person who needs an organ and not for their loved one in the bed.
STEIN: The new policy goes into effect next month.
Rob Stein, NPR News. Transcript provided by NPR, Copyright NPR.
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