I mentioned organ donation a few posts back in regard to the death of UNC mascot Jason Ray. Then I saw (via Slate) this story in the Post about a new model anatomical gift law. (For the nonlawyers, model uniform laws like this are promulgated from time to time by a panel of experts, in order to foster uniformity among state laws. Click that last link for more.) Several states have passed the Revised Uniform Anatomical Gift Act or are working on it.
There are a couple of interesting, and potentially controversial, aspects of the law. Basically, the organ donation decision — often made in haste in the driver’s license line — trumps in most cases. For one thing, the donor’s decision trumps the wishes of family members who might not want to donate a loved one’s organs. For another, it might trump the donor’s decision not to be placed on life support if doctors need to keep the donor alive long enough to get the organs ready for harvesting. Some people are also worrying that it might make doctors more reluctant to administer palliative care if they worry it might damage the organs.
These are the kind of concerns you could spend a semester in a Bioethics class discussing. But I’m cautiously in favor of the revisions. First, the donor’s intent should trump the desires of third parties, but of course it’s desirable for donors to discuss their intent with their families. Second, the living will conflict can be handled with better notice at both ends — perhaps a pamphlet from the DMV when you check the box, and a paragraph on the living will form or something.
Over time, and through experience, I’m sure this new protocol will become the norm. Hospitals will have to get used to it, and while there will surely be glitches, I think overall it will streamline the process and lead to more donations. I think the life support provision might cause some fuss, given the existing controversies over when to declare a patient dead and harvest the organs. But it’s not as if they’d want to keep someone alive Schiavo-style, for years, because that would degrade the organs. At most, I’d think, we’re talking about a few hours or days until the harvesting and donation apparatuses can be put in place.
I think most people who go to the trouble of declaring an intent to donate organs and also execute a living will are going to have some idea that this overlap exists, and will probably be okay with a limited amount of preservation. A little play in the joints, if you will. I know that’s the position I’ll take. So if anyone out there reading this knows me and is around when my end-of-life decisions come into force, I want to donate my organs, and although I don’t want extended life support measures (especially if I’m in a PVS), I’m okay with limited life support until they can harvest me of all the good parts. After that, Dandy Don can take it away: “Turn out the lights, the party’s over….”
(The subject of this post is a line a bum used on me once in New York City.)