Primary care physicians' attitudes and practices regarding discussing organ donation with their patients.

I first began reading this manuscript and thought, “Wow, how great that would be to involve the primary care physician (PCP) in the organ donation process.” Then, I began to read further and I decided what a wellintentioned disservice this could potentially be. This experiment has been attempted before with poor results. However, not to be discouraging, the authors of the paper have gone an extra step to look at an additional process in an attempt to address the ever-increasing shortage of solid organs for transplantation. To their credit, they identified an interesting set of practice patterns in the United States. They queried PCPs on their practice of discussing end-of-life care and whether or not patients seen in their practice would consider donating their organs. As it has been shown in the paper, very few practicing physicians have ever received any formal training in approaching potential donor families (17%). Most of us are aware that this is just not a skill set one acquires either in medical school or during one’s residency training. Furthermore, very few even discuss issues such as advanced directives and end-of-life care with their patients (30%). Even fewer (4%) have talked about organ donation with their patients. Precariously, only 11% reported having donor information available to patients seen in the office. What is a bit disturbing is the fact that very few physicians in the survey have had any formal training in organ donation discussions, yet 36% say it falls within the purview of their practice. Most (64%) appropriately state they are just not prepared enough to have this discussion. As is often the case, many have more on their plate than they can already handle, and adding more responsibility such as teaching or discussing the particulars of the donation process simply lies outside their practice capabilities and is just a burden most choose not to undertake. The survey also takes for granted that most patients make regular visits to the PCP and thus the visit provides the PCP the opportunity to engage in end-of-life and organ donation discussions. One important factor touched upon in the paper was the philosophical question of how do the physicians themselves feel about the donation and transplant process. Too often, I have encountered a health care provider who still believes organ transplantation to be an “experimental” procedure. Most people in the general public have no idea of the success solid organ transplant has enjoyed over past decade. Far too often, practitioners have diabetic and or hypertensive patients in their practice who may be candidates for transplants but do not know the process to refer the patients for transplant evaluation. Many still believe that finances play a role in getting a patient referred and subsequently listed for transplantation. Therefore, if you are unaware of the success transplant has realized, it makes the task of discussing organ donation that much more ominous. This misconception about the lack of success unfortunately does not reside in the older population of physicians. Physicians, like the greater community, often consider themselves to be religious or spiritual beings and therefore the decision for the PCP to be a donor or not may be in part driven by one’s religious affiliation or beliefs. In the manuscript, for instance, 49% of white physicians reported having designating themselves as a potential organ donor. Compare this to 47% in black or African American physicians despite reporting a higher knowledge of organ transplantation. I find it compelling that black or African American physicians responded favorably to understanding organ donation and transplantation, yet they had such a low self-referral to organ donation in the survey. Several organ procurement organizations around the country have proven over and over that the “uncoupling” Author Affiliation: Baylor Regional Transplant Institute (adult and pediatric transplant surgeon) and Children’s Medical Center-Dallas, Dallas, Texas; and Minority Affairs Committee, United Network for Organ Sharing, Richmond, VA (chair). Corresponding Author: Henry B. Randall, MD, FACS, Adult and Pediatric Transplant Surgeon, Baylor Regional Transplant Institute, Baylor University Medical Center, 3500 Gaston Ave, Dallas, TX 75246 (henryran@ baylorhealth.edu).