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.

Fewer 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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