AMA says more data needed on options to boost organ donations

Chicago -- The American Medical Association in June said physicians should encourage and support pilot studies that investigate whether presumed consent and mandated choice could increase organ donations.

The new policy, which calls for support of such studies in relatively small populations, was passed by the Association's House of Delegates.

Under presumed consent, a person's willingness to donate is assumed unless he or she specifically withdraws consent. Mandated choice requires individuals to express a preference regarding organ donation. The policy said neither option should be widely implemented unless data suggest a positive effect on donations.

"At this time, there's not enough data to support a national plan of presumed consent or mandated choice for organ donation," AMA Trustee Peter Carmel, MD, said in a statement. "Last year alone, 7,060 patients on the national organ transplantation list died needlessly because organs were not available. If either of these programs can reduce that number, it's well worth further study."

Dr. Carmel said more than 88,000 patients are on waiting lists for organ transplants. The new policy also helps to raise awareness about the shortage of organ donations, he said.

AMA delegates also approved new ethical policy to serve as a guide to physicians involved in transplanting organs from living donors.

That policy states that every donor should be assigned an advocate team, which includes a physician, that is concerned with the well-being of the donor. The team should provide the donor with information regarding the donation procedure and spell out potential complications to the donor and to the recipient.

In addition, living donors should not receive payment for any of their solid organs, but reimbursement for travel and other expenses is OK. It is ethically appropriate for donors to designate a recipient, whether it's a close relative or a known, unrelated person. Physicians should support the development and maintenance of a national database of living donor outcomes, the policy said.

"These new ethical guidelines will help physicians as they deal with this unique patient population," Dr. Carmel said.

Military resolution draws fire

Also at the Annual Meeting, delegates considered a resolution asking the AMA to conduct an investigation to assure that the U.S. military has looked into medical issues related to alleged detainee abuses in Iraq, Afghanistan and at the U.S. military base at Guantanamo Bay, Cuba.

In the July 7 issue of the New England Journal of Medicine, two medical ethics experts said interrogators at Guantanamo Bay may have breached medical privacy and used prisoners' health records against them.

The article said that since late 2002 "psychiatrists and psychologists have been part of a strategy that employs extreme stress, combined with behavior-shaping rewards, to extract actionable intelligence from resistant captives."

In mid-June, William Winkenwerder Jr., MD, assistant secretary of defense for health affairs, sent a letter about the involvement of military physicians in detainee operations to then-AMA President John C. Nelson, MD, MPH.

Dr. Winkenwerder discussed the newly issued U.S. Dept. of Defense policy on medical program principles and procedures for the protection and treatment of detainees.

He said the policy underscores that medical professionals caring for detainees have a special "duty to protect their physical and mental health."

Dr. Winkenwerder also wrote: "To the best of our knowledge, no investigation has produced credible evidence of any military physician participation in detainee abuse."

During discussion at the Annual Meeting, many physicians opposed the proposed resolution aimed at military doctors, saying it implied that some military physicians were not practicing ethical conduct.

"I have not had one report ... of maltreatment, not even a rumor," said Air Force Brig. Gen. David Young III, MD, an alternate delegate.

Instead of the original resolution, delegates reaffirmed their support of the ethical medical treatment of prisoners of war and detainees.

Delegates also adopted policy that called for the AMA to encourage medical schools to include ethics training on the issue.

During the Council on Ethical and Judicial Affairs open forum at the meeting, delegates talked about issues such as pay-for-performance and law and ethics. CEJA leaders were seeking input from physicians in order to draft ethics reports.

Physicians discussed potential conflicts between legal duties and ethical obligations, especially when dealing with patient privacy and confidentiality of medical records.

According to the AMA Code of Medical Ethics, ethical obligations typically exceed legal duties and, in general, when physicians believe a law is unjust, they should work to change the law.