MEDICINE : Pennsylvania Organ Donor Bill: If You Don’t Say No, It Means Yes

PHILADELPHIA —  A critical shortage of human organ donors prompted a Pennsylvania lawmaker to introduce legislation last week to, in effect, reverse the way organs for transplants are obtained in the state.

State Sen. Michael Dawita of Allegheny County sees his mission as saving lives, but opponents contend that his measure could become a license for body snatching.

THE PLAN: Under Dawita’s proposal, known as “presumed consent,” the state would assume that a person wanted to donate one or more organs after death unless that person had obtained a non-donor card, had checked off a box against organ donation on his state income tax return or had a non-donor sticker on his driver’s license. Additionally, family members would be able to veto organ donation.

Such a policy is common in Europe. A similar bill has been introduced in Maryland, and other states are re-evaluating organ donor legislation.

At least 20 states have partial presumed consent laws covering such “non-vital organs” as corneas and pituitary glands. But if Dawita’s measure passes, it would be the first of its kind in the nation covering vital organs--those whose availability is a matter of life or death.

Current policy requires either the permission of the immediate family or a donor card that says the person wants to donate organs. Proponents say Dawita’s proposal would more than double the number of organs available.

A Gallup poll released Tuesday reported that three-quarters of Americans are willing to donate their organs and more than half would donate those of a dead relative whose wishes they did not know.

“We live in a civilized and compassionate society,” said Dawita, “yet every four hours someone in this country dies because a suitable organ could not be found for transplant. There’s a simple--and deadly--problem of supply and demand.”

OPPOSITION: “I think it raises some significant privacy concerns,” said Larry Frankel, a spokesman for the American Civil Liberties Union of Pennsylvania. “We fought pretty hard for the citizens of this country to have the right to control their bodies. We don’t think that right ends upon death.”

Even officials at the Delaware Valley Transplant program, which covers eastern Pennsylvania and is the largest organ procurement organization in the country, have mixed feelings. Concerned that anger over the “presumed consent” proposal might cut the supply of voluntary donors, they favor an enhanced education campaign.

“Certainly, it’s an interesting idea,” said Dr. Valluvan Jeevanandam of Temple University, the head of the nation’s fourth-largest heart transplant program. “But we don’t want people to think they’re losing control over their body and to start having ideas of body snatching.”

PRESENT POLICY: All 50 states have a form of the 1972 federal Uniform Anatomical Gift Act, which allows citizens to make an express gift of one’s body or parts of it. About one adult in five in America has an organ donor card or a sticker on the back of his or her driver’s license permitting it.

In addition, hospital staff members are required to ask any next of kin if they would agree to the removal of one or more of the deceased person’s organs. But many doctors and nurses do not ask because they feel uncomfortable about it, officials at the Delaware Valley Transplant program say.

In 1992, about 4,500 people nationwide donated one or more vital organs, which, in turn, allowed more than 14,000 transplants, according to the Assn. of Organ Procurement Organizations. However, about 29,000 people nationwide remain on the waiting list for a heart, lung, kidney or other similarly vital organ.

As a result, a major transplant facility in Pittsburgh has begun experimenting with baboon liver transplants to make up for the dearth of human organs. Still, the upsurge in successful transplant operations has made the shortage more critical.

“I think it’s really important” that Dawita’s proposal passes, said advertising art director Jessica Forrest. Her husband has been diagnosed as having kidney failure and is awaiting a transplant. “Even if we could only get a few more people, it would be so worth it.”