Transplant network relaxes firewall between care teams and donor staff

The U.S. organ transplant system will remove a strict barrier between hospital care teams and organ procurement staff on Nov. 18. Under the new guidelines, donation teams may begin conversations with a patient's legal agent while end-of-life discussions are still active. Previously, procurement staff were barred from contacting families until after the decision to withdraw life-sustaining care had been made.

The Organ Procurement and Transplantation Network board voted on Aug. 20 to modify this long-standing rule. The change is part of a broader set of policies governing donation after circulatory death, a process that now accounts for roughly half of all organ donations. The goal is to improve coordination and reduce the risk of procedural errors, such as patients being transported to operating rooms while still alive.

Dr. Raymond Lynch, director of transplantation at the federal Health Resources & Services Administration, argued that the old rule created a false sense of security. He stated that focusing on a bright line without examining the reality on either side of it was insufficient. Lynch described the new policy as a marked improvement in communication between hospital staff, procurement organizations, and families.

The policy also introduces standardized patient protections, including clearer documentation and testing for death. It makes it easier to pause organ retrieval if concerns arise about the patient's condition. Lynch noted that the changes aim to ensure retrieval teams arrive early enough to perform necessary tests without delaying the family's ability to honor a donor's wishes.

More than 109,000 Americans are currently waiting for an organ transplant. Approximately 12 patients die every day due to the chronic shortage of organs. Lynch said that when retrieval teams arrive too late, families lose the memory of helping their loved one, patients lose the choice they made, and waiting list candidates lose the chance to receive life-saving organs.

Critics argue the change blurs ethical lines and may pressure families. Dr. Lainie Ross, a bioethicist at the University of Rochester, said the primary responsibility is patient care. She emphasized the need for a clear separation so that families do not worry that doctors are suggesting treatments are failing because they want the patient's organs. Ross expressed concern that families might feel manipulated or pressured to make decisions too quickly.

Dr. Claire Morgan, a transplant surgeon on the network's Patient Affairs Committee, acknowledged the benefits of transplants but worried about interfering with the grieving process. Lois Shepherd, a professor of law and bioethics at the University of Virginia, said the change is part of a trend of weakening safeguards. Shepherd opposed the modification while serving on the working group that developed the guidelines.

The Association of Organ Procurement Organizations endorsed the change. The trade group stated in public comments that families must be informed about donation timing before they make final decisions. President Allison Erickson said in a written statement that public trust depends on families fully understanding each stage of the end-of-life and donation processes.