Transplant Network Moves Donation Talks Earlier in Hospital Care

The Organ Procurement and Transplantation Network will change how hospitals handle organ donation conversations starting Nov. 18. The new guidelines allow procurement teams to speak with a patient's legal agent while end-of-life discussions are still occurring. Previously, a strict rule prohibited these teams from contacting families until after the decision to withdraw life-sustaining care was final.

The board of directors for the transplant system voted to adopt these changes on Aug. 20 as part of a broader update to guidelines for donation after circulatory death. This type of donation occurs after life support is removed and currently accounts for roughly half of all organ donations. The network aims to reduce errors and increase the number of available organs by starting the conversation sooner.

Dr. Raymond Lynch, director of transplantation at the Health Resources and Services Administration, defended the revision. He stated that insisting on a rigid separation between the care team and the donation team creates a false sense of security. Lynch explained that the new policy is part of a suite of improvements designed to better coordinate communication between hospitals and procurement organizations.

Past incidents have included patients being moved to operating rooms for organ retrieval while still alive. Lynch said the updated rules aim to prevent such mistakes by improving documentation and coordination. The policy also makes it easier to pause retrieval if staff identify concerns and standardizes testing for determining death.

More than 109,000 Americans are currently waiting for an organ transplant, according to federal data. About 12 people die every day due to a chronic shortage of organs. Lynch argued that waiting until the family has made a final decision can be too late to honor a donor’s wishes. He noted that when teams are brought in too late, families lose the memory of helping their loved one, and patients on the waiting list lose a chance at a lifesaving procedure.

Critics, however, argue the change blurs an ethical boundary that protected patients. Dr. Lainie Ross, a bioethicist at the University of Rochester, described the previous rule as a vital bright line. She said the primary responsibility is the patient’s well-being and that teams should not consider organ usability until death is imminent. Ross expressed concern that families might feel pressured or manipulated if donation teams are present during critical care decisions.

Dr. Claire Morgan, a transplant surgeon on the network’s Patient Affairs Committee, acknowledged the benefit of more organs but warned against rushing families. She said she does not want to interfere with a grieving family’s ability to make decisions at a time that feels right for them. Morgan emphasized that transplants provide great benefit to many people but that the timing of the conversation is delicate.

Lois Shepherd, a professor of law and bioethics at the University of Virginia, opposed the change while serving on the working group that developed the guidelines. She described the move as part of a series of developments that are weakening safeguards for patients. Shepherd said the blurring of lines between care and procurement is a source of concern for many observers.

The Association of Organ Procurement Organizations endorsed the new rules. The group stated in public comments that families must be informed about donation timing before they decide to withdraw life support. Many families have expressed frustration with learning about timing impacts only after planning for other relatives to be present. AOPO President Allison Erickson said in a written statement that donor families deserve to fully understand each stage of the process and that the organization is responsible for maintaining public trust.