Authors' response to letter re: The Rapid Assessment of Hospital Procurement Barriers in Donation: Assessing Hospitals for Change

Laura A. Siminoff, Heather M. Marshall TrainoTo the Editor:In their letter to the editor (this issue), Ve-rheijde, Potts, Rady, and Shewmon (2010)equate implementation of the Rapid Assess-ment of hospital Procurement barriers inDonation (RAPiD) with compromising the ba-sic principle upon which the U.S. organdonation system is founded—voluntariness.Specifically, the authors contend that theRAPiD infringes upon healthcare providers’right to ‘‘opt out’’ of or ‘‘conscientiously ob-ject’’ to engaging in ‘‘health serviceprogram[s] or research activit[ies]’’ that are‘‘contrary to his [or her] religious beliefs ormoral convictions’’ (Public Health Service Act42 USC ‰ 300a-7 (d)) (Office of the Law Re-vision Counsel U.S. House of Representatives,1973). The authors seem to overlook the factthat health practitioners’ employment withinany healthcare organization constitutes partic-ipation in neither a ‘‘health service program’’nor a ‘‘research activity.’’ Employees in health-care organizations, such as hospitals, arecontractually obligated to adhere to the poli-cies and procedures of that organization,whether codes of dress or conduct, or policiesrelated to the identification and referral of do-nor-eligible patients to regional organprocurement organizations (OPO). Moreover,these policies are in response to federal andstate regulations.Hospitals’ organ donation policies are theproduct of national regulatory efforts to in-crease the supply of transplantable organs. Inthe late 1970s, it became apparent that thoseon the transplant waiting list far exceeded thenumber of organs available. Some arguedAmericans wanted to donate and that the or-gan shortage reflected a failure on the part ofhospital staff to approach families and ask fordonation. These assumptions resulted in a se-ries of new state and federal laws intended toincrease the supply of transplantable organs.These laws, commonly called ‘‘required re-quest,’’ were designed to encourage healthcareprofessionals to speak with families about or-gan donation (Caplan, Siminoff, Arnold, V however, this didnot happen. After an initial modest increase,donations leveled off to no more than 5,000donors per year. One problem was that at least50% of all requests for organ donation to fam-ilies of brain dead patients were met withdenial (Siminoff, Arnold, Caplan, Virnig, S Cohen, 1992; Kappel, Whitlock, Parks-Thomas, Hong, & Freedman, 1993). ‘‘Re-quired notification’’ was enacted in 2001 toattempt to address this concern. This policyobligates hospitals to report all deaths to a localOPO to determine patient eligibility for organdonation. The purpose of routine notificationis to try to increase OPO involvement in thepatient identification process so as to improvethe request process (Health Care FinancingAdministration, 1998). Siminoff, Gordon, Hew-lett, and Arnold (2001) and Evanisko et al.,(1998) have demonstrated that OPO staff arebest qualified to discuss this option with fam-ilies.Thus, healthcare organizations are federallymandated to report all potential donor-eligiblepatients to regional OPOs in a timely manner.A timely referral is made within 1hr of a pa-tient meeting the clinical triggers for referral,that is the absence of brain stem reflexes, aGlascow Coma Score45 or the considerationof withdrawal of care (Ehrle, 2006). Hospitalpolicies concerning the identification and re-Vol. 32 No. 3 May/June 2010 45