Primary care doctors should discuss organ donation with patients

Originally published in MedPage Today

by Charles Bankhead, MedPage Today Staff Writer

Primary care physicians rarely discuss organ donation with patients, even though most of the doctors believe organ donation is within the scope of their practice, a survey of primary care physicians showed.

Primary care doctors should discuss organ donation with patientsFewer than 4% of physicians said they discussed organ donation with patients, compared with 30% who discussed end-of-life issues. Almost two-thirds of the physicians said organ donation is not outside the scope of clinical practice.

Most often, discussions about organ donation occur with grieving individuals who are trying to cope with a friend or family member’s imminent death, or during applications for drivers’ licenses and renewals.

The survey findings suggest a need for increased involvement of healthcare workers, and more specifically, primary care physicians, according to authors of an article in the January issue of the Journal of the National Medical Association.

“With more than 100,000 Americans waiting for organ transplants, it is crucial that we find new ways to increase donation,” J. Daryl Thornton, MD, of MetroHealth Medical Center in Cleveland, said in a statement. “New efforts should focus on improving communication on the subject between healthcare providers and their patients.”

Discussion of organ donation with a primary care provider might increase patients’ willingness to donate, Thornton and co-authors wrote. However, the frequency of such conversations had not been reported.

To examine the issue, the authors conducted a mail and Internet-based survey of a national sample of 831 primary care physicians, with oversampling of African- American and Hispanic physicians. Respondents comprised 233 non-Hispanic blacks, 194 Hispanics, and 277 non-Hispanic whites.

The 41-item questionnaire elicited information about respondents’ demographics and practice patterns, professional knowledge about organ donation, and personal experience with organ donation, including their own willingness to be organ donors (live or deceased).

White physicians tended to be older than blacks and Hispanics (47.3 years versus 43.6 and 44.8). More than half of the black physicians were women, compared with a quarter of Hispanics and a third of whites. About 60% of whites were family physicians, whereas 55% of blacks and 57% of Hispanics were internists.

Overall, 97% of respondents expressed support for organ donation, with relatively small proportions saying they would be unwilling to donate their own organs (7% of whites, 11% of Hispanics, 17% of blacks).

Responses showed that 47% of blacks had signed a donor card, compared with 61% of Hispanics and 79% of whites.

Overall, 4% of physicians said they had discussed organ donation with more than half of their patients. The authors found that 5% of physicians had donor cards in their offices, while 11% had information about organ donation, and 50% could cite sources of information for patients.

In contrast, 29% of black physicians, 36% of Hispanics, and 23% of whites had discussed end-of-life issues with patients (P=0.01, Hispanics versus other two groups).

Responses showed that 16% of physicians received training in organ donation during medical school and 17% afterward.

However, 71% had provided care for a transplant recipient. Most respondents felt they had inadequate knowledge about organ donation, but only 36% thought that discussion of organ donation was outside the scope of their practice.

A multivariate analysis revealed only two significant predictors of organ donation discussions: donation education during or after medical school (OR 2.6, 95% CI 1.00 to 6.5, P<0.05) and discussion of end-of-life issues with more than half of patients (OR 12.8, 95% CI 4.2 to 39.00, P<0.001).

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  • http://www.insweb.com/home-insurance/home-insurance.html Health Insurance Advocate

    Fantastic article. I think doctors should discuss organ donation, too. I’m currently an organ donor, but I only came to the conclusion through my own decision, not because a doctor suggested it. I think it’s a great idea and more people would be willing to donate if a trusted doctor explained it to them.

  • Rezmed09

    As a doc who frequently has these discussions with patients and families, I believe that this approach is problematic on so many levels.
    Apart from the time and money issues that will be brought up, the bigger picture is that primary care office isn’t the best place for this discussion to start. My patients are sick and old. It has to start with more media – more specific PSA messages and the message needs to be intensive in the transplant centers and focused on the families of those needing organs.

    Ask your cadaveric transplant patients and their families. Find out if anybody at the transplant center ever asked them “if someone in your family died in an accident would you allow the doctors take out your loved one’s organs and give them to a stranger?” The answer will be no in too many cases.

  • Primary Care Internist

    ridiculously idealistic from someone who has NO IDEA what primary care medicine is like. Really, how many things can/should be discussed at a primary care office visit? already aside from the actual MEDICAL problems, of which the physician is most qualified to manage, these other issues e.g. advanced directives, hc proxy, living will, organ donation, and even weight loss, risky behaviors, seatbelts, spousal abuse, substance abuse etc. all are much better addressed by someone who has more time and interest in doing such. Not that these aren’t important, but it doesn’t take 7+ years of post-bacc education to address this stuff. Whereas it DOES take it to manage someone’s diabetes, for example.

    So silly – must’ve come indirectly from our politicians.

  • pcare doc

    Totally agree with Primary Care Internist. This is unbelievably naive. There are so many lower-cost ways to encourage the public to discuss organ donation with their family than to encroach on invaluable primary care visit time.

    I love the way people seem to think a primary care visit is this relaxed, carefree time when people can sit around and philosophize about life goals.

  • http://doctorstalkradioshow.blogspot.com/ Dr. David

    I’m a little disheartened by Primary Care Internists’ disdain for discussing “advanced directives, hc proxy, living will, organ donation, and even weight loss, risky behaviors, seatbelts, spousal abuse, substance abuse” with his patients. According to the Cochrane review, simple advice from physicians to smokers increases the chance of smoking cessation. If true, is this such an unworthy way for an internist to spend time doing? And given the addictive potential of nicotine, I would expect that simple advice from physicians re: seatbelt use, etc. to be even more effective. Clearly face to face time with patients is limited, but is it unreasonable for primary care physicians to facilitate educational interventions to be conducted while the patient is waiting in the waiting room or in the exam room?

  • Primary Care Internist

    Dr.David, what kind of doctor are you exactly? If you are a primary care physician managing elderly patients with multiple comorbid conditions, using an EMR (which only ADDS work, rather than creating new efficiencies), and counseling/advising on all the above issues I mentioned, then I applaud you.

    And if you are not a primary care doc, but still see patients, then you are in just as good a position as me to discuss the above. So I assume you do regularly.

    I don’t have “disdain” for discussing these things – on the contrary I feel they’re extremely important. But the primary care visit is already stretched way too thin, and should be used to address issues that can’t be easily done by someone else (like which class of hypertension med is appropriate, what health screening tests are indicated now, what to do about this cough i’ve had for 4 months, or the nontender lymph nodes in my neck i’ve had for 6 weeks, or is physical therapy alone enough for my back pain or should i have an MRI and ortho consult, and the 1000 other scenarios that really warrant the attention of a primary care doctor).

  • http://doctorstalkradioshow.blogspot.com/ Dr. David

    Primary Care Internist–Your general point about ensuring that doctors focus on the tasks requiring the most medical training is well made. However, you didn’t address my recommendations. Is the time patients spend in the waiting room or in the exam room waiting for you being maximally used to accomplish some of these other, educational objectives?

  • LIFESHARERS

    Your story about Organ Donation highlighted the tragic shortage of human organs for transplant operations.

    Over 50% of the people on the national transplant waiting list will die before they get a transplant. Most of these deaths are needless. Americans bury or cremate 20,000 transplantable organs every year.

    There is a simple way to put a big dent in the organ shortage – give donated organs first to people who have agreed to donate their own organs when they die.

    Giving organs first to organ donors will convince more people to register as organ donors. It will also make the organ allocation system fairer. People who aren’t willing to share the gift of life should go to the back of the waiting list as long as there is a shortage of organs.

    Anyone who wants to donate their organs to others who have agreed to donate theirs can join LifeSharers. LifeSharers is a non-profit network of organ donors who agree to offer their organs first to other organ donors when they die. Membership is free at http://www.lifesharers.org or by calling 1-888-ORGAN88. There is no age limit, parents can enroll their minor children, and no one is excluded due to any pre-existing medical condition. LifeSharers has over 13,400 members at this writing.

    Please contact me – Dave Undis, Executive Director of LifeSharers – if your readers would like to learn more about our innovative approach to increasing the number of organ donors. I can arrange interviews with some of our local members if you’re interested. My email address is daveundis@lifesharers.org. My phone number is 615-351-8622.