GENERAL PURPOSE: To persuade.
SPECIFIC PURPOSE: To persuade the class of the importance of discussing their decisions concerning organ donation openly and clearly with family members.
PATTERN OF ORGANIZATION: Problem/Solution
INTRODUCTION:
In 1994, a beautiful little girl was born. She was the first girl-child in her family in nearly 30 years. She was treasured by her family and especially by her three older brothers. She was perfect in every way--as delicate as a flower but lively and strong.
Her second birthday, however, was overshadowed by the grim reality that this birthday might be her last. Her devastated family had been informed that she had an incurable heart problem and that there was no hope for her. They were urged to place her on a Make-a-Wish Foundation list. After the initial horror dulled, however, her mother pulled together her considerable maternal resources and made the wise decision not to accept her child’s death is inevitable, but to seek a second, or even a hundredth opinion, if necessary.
At her urging, a friend of the family with access to a computer managed to locate a doctor on the Internet who felt that he might be able to help the child. Though the diagnosis he expected was proven incorrect, he directed the family to the fine doctors at Loma Linda University Hospital -- a pioneering pediatric transplant hospital in Loma Linda, California, where she was correctly diagnosed. Apparently, sometime between birth and 6 months of age, she had contracted a virus -- a simple organism that exhibited symptoms of a cold -- nothing to worry about -- except that it violently attacked her heart muscle.
By the age of 2-1/2, her heart was so damaged that the fact that it continued to beat was a miracle. Even so, it could not support the needs of her small body. Her heart was so enlarged that if filled her abdominal cavity. It compressed her lungs, her esophagus, and her stomach. Her breathing was a watery pant; and though she struggled to swallow food, she could not. She could not sleep through the night, but woke often screaming in terror or pain. At 2-1/2, she weighed a mere 19 lbs. The choice given to her parents was deceptively simple: She needed a new heart or she would die.
As spiritual people, her parents were conflicted about praying for a new heart. They understood that if their prayers were answered, another child would have to die. They reconciled this dilemma in their hearts by placing the name of their precious little girl on the organ donation list, just in case she could not last long enough for a new heart, or did not survive the surgery and recovery.
The decision having been made, her name was placed on the organ recipient waiting list. Fortunately, since her other organs were healthy and she was not bedridden, she was an excellent candidate for a high place on the waiting list for a healthy heart. Her family was given a beeper with instructions that when and if a new heart was available, they would immediately be summoned to the hospital, day or night. With anticipation and dread, they waited for the hopeful yet ominous sound of the beep that would change their family forever.
Now I’d like to explain to you some of the factors involved in determining whether or not people like this little girl will be given the "gift of life" or whether they will languish and die because there are not enough organ donors to meet the needs of organ recipients. I will tell you what steps the medical community is taking to alleviate this shortage; and how the law makers have struggled with this issue. Most importantly, however, I will explain how the people in this class alone could save the lives of at least 147 people.
BODY
I. There aren’t enough transplantable organs to meet the needs of recipients. Peter MacPherson tells us that "In 1994, 42,000 Americans languished on transplant waiting lists, and 3,100 died waiting," because families refused to donate the recently deceased’s organs.
A. Health Care Professionals: Deborah L. Shelton, in an article written for American Medical News, states that "Physicians and other health professionals may be partly to blame. An estimated 5,600 more lives could be saved each year if hospitals did a better job identifying potential donors and requesting donations from families, according to a new study (Critical Care Medicine, March 1996)." She goes on to say that an estimated "twenty-seven percent of potential donors were lost either because they weren’t identified or their families weren’t asked." A majority of potential donors over the age of 50 were overlooked entirely. Physicians are in a position to encourage patients to sign donor cards and discuss organ donation with their families and some health professionals do not provide effective communication and counseling with prospective donors and their families regarding donation possibilities.
B. Legislation: The current law in most states provides that either by donor card affixed to the drivers’ license, or by legal documentation (i.e., living will, durable trust, or advance directive) adults are given the opportunity to choose to be organ donors in case of death. However, except for Texas, Virginia, and Pennsylvania which have enacted laws limiting the involvement of the next of kin in the organ donation process, even if the person has identified himself or herself as a donor, that option may be overruled by family members. There are several proposed legislative changes to simplify this process, each of which carries its own ethical considerations:
1. Mandated choice: According to Ann C. Klassen and David K. Klassen in an article written for Annals of Internal Medicine, there is "evidence that families requested to permit organ donation refuse half the time..." This startling evidence led to the proposition of mandated choice, which would require adults to declare their wishes concerning organ donation. Unlike the present law, their wishes could not be overridden by family members. The ethical problem with this legislation is: Should the wishes of the family be respected even when the prospective donor’s wishes are known? According to Aaron Spital in a rebuttal article, "By moving the decision-making process to a relaxed setting and ensuring that a person’s wishes would be honored, mandated choice would hopefully take advantage of favorable public attitudes toward donation and thereby facilitate organ procurement."
2. Presumed consent is another alternative proposed legislation in which everyone would be considered a potential donor unless he or she carried a card objecting to donation. Proponents of this legislation "see it as a means to make it easier to donate than to not donate, eliminate the need for health care providers to request donations from families, [and] spare families from making the decision about donation at times of vulnerability..." as summarized by Judith A. DePalma and Richard Townsend in an article written for Critical Care Nursing Quarterly. Opposing points of view argue that presumed consent violates "the principle of autonomy by denying patients and families participation in the decision" and that informed consent would not be guaranteed.
3. Financial incentives have also been proposed ranging from assistance with funeral expenses to reduced estate taxes and free medical care. Proponents of the financial incentive solution believe it would stimulate interest in organ donation; however, those opposed feel that altruism is the only acceptable motivation for organ donation and that financial incentives would provide the potential for coercion and bartering. To combat this negative potential, DePalma and Townsend suggest that financial incentives probably should not be discussed with families until after the decision to donate organs has been made, or only if the family expresses concerning about hospital costs.
C. Ultimately, though, people like you and me hold the power of life and death in our hands.
1. The African American Problem: According to author Donna Webster-Davis in an article entitled "Organ donation: giving the gift of life" in Essence magazine, "Too few African-Americans donate organs." She cites Mary Ann Wirtz, the spokesperson for the United Network for Organ Sharing (UNOS), "77.4 percent of all organ donors in 1995 were White, while only 11.4 percent were African-American. This statistic is particularly alarming, considering that African-Americans comprise 27 percent of the patients on the national waiting list for organ transplants." Since many types of organ transplants rely on genetic-based tissue types, clearly an African-American donor organ would be far more compatible for an African-American recipient than a White donor organ. She goes on to state: "Because we die of kidney disease in disproportionate numbers and make up 35 percent of the kidney-transplant waiting list, the need for this organ has reached a crisis level in our community." She suggests that African-Americans are typically squeamish about organ donation and how the deceased loved-one will look at the funeral. Instead, the author remarks "...organ donation is about hope. It’s about giving the gift of life."
2. For most people, the simple steps toward organ donation break down somewhere in this chain: First, they may not even consider organ donation; second, if they have considered it, they may not have documented their decision by carrying a signed and witnessed organ donor card; and finally, if people have reached the point of making the decision and carrying an organ donor card affixed to their drivers’ license, they may not have discussed their decision with their family. While a signed and witnessed donor card is legally binding in every state, a relative must also give consent. Unfortunately, in about 50 percent of the cases where a potential donor has signed such a document and could have saved many lives, a family member has denied permission simply because the wishes of the donor were not made known to the next of kin beforehand. The families may think the donor will be mutilated; or they may think that donation is not allowed by their church; or they may think that donation will be more costly for them or their insurance carrier.
II. Solving a supply and demand problem is simple; you either diminish
the demand (wouldn’t that be great?); or you increase the supply -- in
this case, the number of donors must be increased. The physicians and health
care professionals are revamping their approach to shoulder their share
of responsibility and the law-makers are trying to draft humane laws that
will take everyone’s rights into consideration, but only people possess
the power to make the difference. The following steps are critical:
A. The prospective donor must be properly informed about organ donation.
B. The prospective donor must initiate documentation setting forth his or her wishes concerning organ donation. In Colorado it is mandatory to respond to the organ donation question in order to renew one’s drivers’ license.
C. The prospective donor must freely and convincingly discuss his or her wishes with family members and loved ones so that at the time of crisis, the wishes of the donor will be respected.
D. Health care providers must provide effective communication and counseling with prospective donors and their families regarding donation possibilities.
CONCLUSION
In conclusion, you have learned some of the reasons why thousands of people die each year waiting for organs and what your role is in solving the problem. I’m sure you remember the case of seven-year-old Nicholas Green who was shot in the head while traveling with his parents in Sicily. By the incredibly generous act of his parents, Reg and Maggie Green, seven Italians desperately in need of organs for their survival, received life’s gift from Nicholas. That story became news and was made into a movie for television which I have convinced the network to air tomorrow night. Maggie Green states that "The resulting dramatic increase in organ donations in Italy has been called ‘the Nicholas effect.’"
Everyday, across this nation, stories just like the "Nicholas" story are played out quietly, and with dignity. Unfortunately, though, too few. In "A Simple Act", published by The Journal of the American Medical Association, Reg Green stated "The donation, then, wasn’t a particularly magnanimous act. On the other hand, not to have given would have seemed such an act of miserliness that I don’t believe I could have thought about it later without shame. The future of a radiant little creature had been taken away. It was more important than ever that someone else should have that future."
The Greens, bless them, have been an inspiration to millions of people by their brave and generous act. Just as the parents of a child somewhere in the Midwest saved the life of this child, my beloved, bright, and beautiful niece, Peyton, and 6 other children through an act of profound kindness and generosity. A celebration of Peyton’s life was marked on her third birthday in a beautiful park with many children, a clown, family members, friends, medical personnel, the press and even well-wishers unknown to the family. All were enchanted by the sight of this healthy, pink-cheeked, pale-haired, energetic, intelligent and saucy little girl running and playing. Six months after the surgery, her heart biopsy revealed no rejection attempts by her body. She knows she has a new heart. She calls the fading scars on her chest her "beauty marks". Each and every day of her life is a precious and treasured gift for which we are and will continue to be profoundly grateful.
If you are interested in organ donation either for yourself or your children, I have provided information and examples of donor forms for you here on the desk. I urge you to pick up a packet on your way out of class.
SOURCES
Websites:
http://www.angelfire.com/biz/Transplants4Children/index.html
http://www.shareyourlife.org/
http://organdonor.gov/
http://207.87.26.13/Newsroom/Frame_news.asp
http://www.cota.org?
http://www.ctdn.org/giftoflife.html
http://www.unos.org/main_default.htm
Articles:
Essence, "Organ donation: giving the gift of life," by Donna Webster-Davis, July 1996 v27 n3 p134(1).
Annals of Internal Medicine, "Who are the donors in organ donation?", by Ann C. Klassen and David K. Klassen, July 1, 1996, v125 n1 p70(4).
Annals of Internal Medicine, "Mandated choice for organ donation: time to give it a try," by Aaron Spital, July 1, 1996, v125 n1 p66(4).
Hospitals & Health Networks, "A pitch for organ donations", by Peter MacPherson, February 20, 1996, v70 n4 p76(1).
Critical Care Nursing Quarterly, "Ethical issues in organ donation and transplantation: are we helping a few at the expense of many?", Judith A. DePalma and Richard Townsend, May 1996, v19 n1 p1(9).
American Medical News, "Physicians hold key to boosting organ donation, awareness," by Deborah L. Shelton, May 6, 1996, v39 n17 p11(1).
Medical Update, "Sharing your life at death: how to assure organ donation wishes," by Edwin W. Brown, February 1997, v20 n8 p4(1).
RN, "Organ donation: the legal aspects," by Linda F. Heffernan, February 1988, v61 n2 p51 (4).