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Washington Diary

A Dead Issue

By Margaret Carlson

TIME magazine

TIME, April 27 -- There's a lot to overcome in deciding to donate your organs: the specter of death for one thing, signing documents for another. This week three members of Congress who cover all the organ-donation bases--Senator Mike DeWine, who made the issue his top priority after having to make a split-second decision to donate the organs of his 22-year-old daughter killed in a car accident in 1993; Senator Bill Frist, a surgeon who actually did transplants; and Representative Joe Moakley, who walks the halls of Congress thanks to a donated liver--will launch National Organ and Tissue Donor Awareness Week and celebrate the fact that this year, for the first time, 70 million Americans will get donor cards along with their tax refunds.

That's a lot of congressional wattage, but hardly a match for the power of Mike Wallace. 60 Minutes delivered a blow to the cause last week in a piece that posed the question, "Are surgeons taking organs from patients who are not quite dead?"

It isn't hard to scare the bejesus out of people in matters existential--like When am I dead? At one time the notion of removing body parts was so ghoulish that families hardly discussed it and doctors, in the infancy of transplant technology, rarely raised it. Even now, after decades of increasing public comfort, the thought that a hospital might be eyeing you not as a patient to be saved but as a new liver for Mickey Mantle is very spooky.

The 60 Minutes piece featured an attorney pushing a novel murder defense: that the victim was killed not by his client but by the harvesting of her organs. This was followed by an interview with an ethicist concerned that protocols proposed at the Cleveland Clinic would allow organ-preserving drugs to be given to patients expected to suffer cardiac death after life support is withdrawn. The ethicist feared that these drugs could actually hasten death.

Boffo television. But there may be less controversy here than meets the CBS Eye. The murder case was 10 years old. The protocols, though never implemented by the Cleveland Clinic, are used elsewhere and are supported by Dr. Hans Sollinger, president of the American Society of Transplant Surgeons. A 1996 study of 500 hospitals found that about a third of the institutions that responded used cardiac-dead donors, some presumably injected with organ-preserving drugs. Cardiac dead used to be the most dead you could be. It wasn't until the late 1960s that new laws added the standard of brain dead. Hospitals make sure that the physician who officially declares death and the transplant team are separate, and that the family alone decides when to end life support and can refuse to donate organs even if a patient has a donor card. In an interview Wallace says he is happy to have brought the issue to light but adds, "I haven't torn up my donor card," though he wonders who would want his parts. Controversy aside, what DeWine wants is for the irs-mailed donor cards to get people to face the issue calmly, not after a loved one has been unexpectedly struck down. "At that moment you can hardly think straight, you're so grieved," he says,"and too many people say no when, if they had thought about it earlier, the vast majority would say yes." What better time than the moment when the government is giving you money. Your check is in the mail--and so is your donor card.

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