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Families say 'no' to organ transplants

作者:伯摇叹    发布时间:2019-02-28 02:02:01    

By Vincent Kiernan PEOPLE are much more reluctant to donate their relatives’ organs for transplant than expected, according to a study carried out in two American cities. The findings leave little hope that the shortage of organs will soon be eased. The organ shortage is generally blamed on the reluctance of doctors to approach grieving relatives with such a sensitive request. People would willingly agree to organ donation if only they were asked, or so many thought. But the study, carried out by researchers in Pennsylvania, shows that even when asked more than half of all families say no. “People just don’t want to do it,” says Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania and one of the leaders of the study. Researchers examined the medical records of 10 681 people who died in 23 hospitals in Pittsburgh, Pennsylvania, and Minneapolis-St Paul, Minnesota, in 1991 and 1992. Within two weeks of each patient’s death, the teams interviewed the doctors who had cared for the patient or had discussed organ donation with the patient’s family. Contrary to received wisdom, doctors were not shy about asking the families of eligible patients to allow the use of organs or tissues. Doctors asked around three-quarters of the eligible families whether they would allow some of their relative’s organs or tissues to be used for transplants. But the families were equally forthcoming in their refusal. Of those asked, only 46 per cent agreed to donate organs, 34 per cent agreed to donate tissues such as skin, and 24 per cent agreed to donate corneas. The decision depended to some extent on the age of the patient who had died (See Table). Nationwide, there is probably even greater resistance to the idea, says Caplan. Pittsburgh and Minneapolis-St Paul are home to large medical centres that perform highly publicised transplants, so local people probably have a better idea than most of the value of transplants, says Caplan. Some families refused for religious reasons. Others were offended that they had been asked at such a traumatic time. Still others refused their consent because they felt that organs were not allocated fairly, with the wealthy receiving more than their fair share, says Caplan. Since the 1980s, doctors in many states have been legally required to ask families to consider organ donation. These results suggest that people often refuse because of deep philosophical and religious beliefs and so are unlikely to be persuaded. The findings also suggest that some of the proposals for increasing the supply of donor tissues and organs may be misconceived. Any attempt to change the law so that consent is presumed unless people register an objection is probably doomed. Given the deep-seated objections to organs donation, “the political chances of getting that to happen are nil”, says Caplan. Another proposed cure for the organ shortage is to make people specify whether they will donate their organs when they apply for a driving licence or fill in their tax returns. The new study suggests that many people will just say no, says Caplan. Indeed, when this system of “mandated choice” was introduced in Texas, 8 out of 10 Texans refused to donate their organs. “Given the common fear, particularly among minorities, that people who are willing to donate may be declared dead too soon, mandated choice may result in a lower, not higher, consent rate,” concludes the study, which is reported in the latest issue of the Annals of Internal Medicine. In the light of the study, organ transplant groups around the US will probably re-examine their strategies for encouraging donations, says Esther Benenson of the United Network for Organ Sharing,

 

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