Harvesting Organs From Silence 

Imagine the government deciding that, with or without your consent your organs will be donated upon your death. Sound like a farfetched "Big Brother" scenario? Think again. 

In 26 states, doctors already can obtain organs for transplantation and research with presumed consent. Presumed consent enables the legal removal of tissues and organs ‑ such as corneas and kidneys ‑ without prior permission of the deceased or his family. 

Few people in the affected 26 states know about the law. Fewer realize that there is a burgeoning movement to make presumed consent widespread. It has been recently adopted by Brazil, Italy, Poland and Switzerland. Closer to home, it was recently adopted in parts of several states, including Texas. Presumed consent has been defeated in debate on the floor of the American Medical Association, but in its medical journal, The Lancet, medical experts have proposed adopting it as a policy. 

There are increase the number of donated organs:

These measures arise from the desperation of doctors who see 10 patients die every day because they need organs. "People get desperate," notes Dr. Clive Callender, chief of Howard University's transplantation program, "But presumed consent has no place in the minority community They already presume not to donate. 

"Presumed consent may be popular in other countries, but we must remember that the minority population is distrustful because we have a history of being abused," says Callender, who supports mandated choice.

 "There are specific reasons why we are often suspicious of attempts to part us from our organs. You have only to think of Tuskegee to understand our reluctance, but there's also the fact that more Blacks than Whites have hysterectomies and amputations," he adds. "Increasing minority donations requires a different modus operandi. That's why our efforts have long been in the direction of talking to people about the issue so that they can think about it without pressure and can make an informed decision." 

The key to increased minority donations, he says, is community education, such as the National Minority Organ Tissue Transplant Education Program in the Washington, D.C., motor vehicle bureaus. "Between 1982 and 1988, we increased the number of people who opted to donate organs from 25 to 750 per month."

Dr. Aaron Spital, a nephrologist at Genesee Hospital in Rochester, N.Y., and an associate professor of Medicine at the University of Rochester, also supports mandated choice. He says that nearly half of all American families are willing to consent to organ donation for a recently deceased family member and that figure would rise to 75 percent if people were required to make a decision. "The whole point is taking the decision out of stressful deathbed scenarios." 

John G. Corry, a minister and lawyer who teaches health law and ethics at Meharry Medical College in Nashville, Tenn., agrees. "I don't have any problems with the mandated‑choice option. But I see serious ethical and legal problems with presumed consent and conscription. Each has elements that constitute an invasion of privacy. For some, removing organs is dismemberment, raising theological concerns relating to resurrection."

 Why is presumed consent finding its way onto the books when mandated choice seems less ethically fraught? Politics, says Dr. Joye M. Carter, chief medical examiner for Harris County, Texas. ‑The law that permitted harvesting of heart valves was passed in D.C. by a city council. Here you have a Black city with a majority Black city council listening to organ groups. This helped the hospital and transplant center, but the law says the citizens who were affected don't have the ability to sue."

 Money is another motive, says Carter. "There is an acquisition fee, money that is passed to insurance companies, for organs. The Los Angeles coroner's office takes corneas and makes a lot of money from it.

 "This is unfair because no one is going to take organs from the rich and famous."

Emerge, Nov. 1998