REPORT OF COMMITTEE ON BLOOD AND TISSUE USAGE
CM-BTU Report 2-A-07
Subject: Policy Review
Presented by: Kevin Land, MD, Chair
Referred to: Reference Committee on Science and Education
House of Delegates policies in the association's Policy Compendium are reviewed periodically for relevance and appropriateness.
280.010 Organ Transplants. All available means should be used to encourage professional associations to develop guidelines for an appropriate protocol for recognition and identification of donors for organ procurement in every hospital in Texas. Physicians, nurses, hospital administration, and the public should be educated as to the need for organ donation to meet society's expectations of availability for transplantation. Organ procurement efforts should remain primarily within the private sector. The Texas Medical Association supports efforts to find private sector solutions, recommend ways to reach potential donors, and identify the best method of coordinating these gifts with the best medical ability and of the continued education of physicians in organ transplantation (Council on Scientific Affairs, p 133, A-93; reaffirmed Council on Scientific Affairs, p 130, A-94; reaffirmed CM-BTU Rep. 2-A-05).
280.022 Organ Donation . TMA supports requiring all individuals under age 70 to express their opinions regarding organ donation before a driver's license is issued or renewed, and favors including information on organ donation on driver's license applications and renewal forms to better educate individuals on the importance of organ donation (Resolution 29F, p 151, A97).
The committee recommends the following language that best represents current legislation to replace these policies.
Organ Donation and Transplantation . In keeping with calls from the Institute of Medicine and other national organizations, the Texas Medical Association enthusiastically supports efforts to increase the rate of organ donation and availability for subsequent transplantation while maintaining the respect and dignity of all Texans by:
1. Urging individuals and families to record their choice of organ donation through a state-sponsored program currently called the Donor Education, Awareness Registry (DEAR) Program, to frankly discuss organ donation decisions and to consider providing consent for donation if a deceased family member had not indicated such a decision.
2. Advising all health-care professionals to expand opportunities for donation by:
a. Initiating discussion with patients as appropriate.
b. Contacting relevant hospital-based organ procurement organization (OPO) representatives when a patient death is imminent or anticipated to facilitate evaluation of the patient as a potential donor.
c. Being actively involved in and/or cognizant of respective institutional donation policies, especially considering hospital protocols and Medicare Conditions of Participation concerning the use of trained requestors to approach families about consent to donation.
3. Continuing to increase health-care professional awareness of and provide ongoing education for ethically-appropriate initiatives to expand donor opportunities, including:
a. Donation after cardiac death, where donation may occur after cessation of cardiopulmonary function and an appropriate waiting period, in the absence of traditional neurologic brain death criteria.
b. The appropriate evaluation and use of organs from extended criteria donors, where practitioners may not be aware of current inclusion criteria (including increased age, split organs, domino transplants, living-related donors).
c. Preliminary discussion and exploration of additional efforts to expand the donor pool, including mandated choice (where individuals are required to make a decision about donation) and presumed consent (where individuals are required to opt or contract out of donation, donation becoming the default option).
4. Striving to foster and support state and federal legislative initiatives to improve rates of organ donation and subsequent transplantation.
TMA House of Delegates: TexMed 2007