Doctors, Not DMV, Should Lead Organ Donor Push, Says Study

Primary care physicians could increase Americans' willingness to become organ donors by educating their patients on the process during routine office visits and discussions about end-of-life care, according to a study in the January issue of the Journal of the National Medical Association.

"With more than 100,000 Americans waiting for organ transplants, it is crucial that we find new ways to increase donation. New efforts should focus on improving communication on the subject between healthcare providers and their patients," said J. Daryl Thornton, MD, lead author of the study.

Thornton conducted the research as a scholar with the Harold Amos Medical Faculty Development Program, a national program of the Robert Wood Johnson Foundation. Thornton is medical director of the Medical ICU at MetroHealth Medical Center in Cleveland and an assistant professor at Case Western Reserve University. He is also a researcher at the Center for Reducing Health Disparities at MetroHealth and CWRU.

Most often, the decision about organ donation is made by individuals coping with the death of a family member. Obtaining consent for organ donation under these circumstances is complicated, sensitive, and often unsuccessful. Most individuals who are organ donors make the decision during a visit to their local departments of motor vehicles, where workers are often not fully trained to address questions about the topic, the study found.

Shifting the location for requesting consent to a routine patient care setting may have an important impact on the number of organ donors, according to the study. About 65% of physicians surveyed agreed that organ donation discussions were within the scope of their medical practice, but only 4% reported having discussed the subject with their patients.

This is in spite of the fact that 30% of physicians reported talking about end-of-life care with their patients. The authors believe the study is the first to report on the paucity of organ donation discussions among primary care physicians and their patients.

According to physicians, the reasons for the low number of organ donation discussions include: the lack of formal training in organ donation, with only 17% of physicians receiving such training; and the lack of staff to address organ donation issues with patients, as reported by 64% of physicians. A small percentage of doctors reported having donor information available in their medical offices (11%), with even fewer having donor cards available (5%).

Primary care physicians, who had received organ donation education or who regularly discussed end-of-life issues with their patients, were more likely to talk about organ donation issues, the study found.

For this nationally representative study, 831 family and internal medicine physicians were surveyed. Hispanic and African-American primary care physicians were oversampled to determine how frequently they discussed donation with their patients and what factors encouraged or inhibited such discussions.

Race and ethnicity of primary care physicians may play an important role in improving organ donation, particularly among minorities. African-American and Hispanic physicians are likely to care for patients of similar race and ethnicities, according to the study.

As of Jan. 6, there were 105,307 people waiting for organ transplants, according to the United Network for Organ Sharing. People of color are disproportionately in need of donated organs, making up more than 50% of those waiting for a donation. African Americans, who comprise only 15% of the population, represent more than 25% of those on organ donation lists, and are more likely to die while waiting for an organ transplant.

"Increasing organ donation among people of all ethnicities should be a national healthcare priority. By increasing the number of organ donors, we can extend both the length and quality of life for those who need transplants," Thornton said.