NY Panel Proposes "Donor Advocate" Team for Liver Donors

An independent "donor advocate" team -- perhaps consisting of a doctor, a transplant coordinator, and a social worker -- is under consideration by a New York state medical advisory panel looking for ways to better protect the safety of would-be liver donors.

"The donor is different than any other patient in the hospital because we have nothing to offer him except physical risk," said Nancy Dubler, head of bioethics at Albert Einstein College of Medicine.

The team of "donor advocates" would advise the would-be donor on the risks and possibly even override the person's decision to undergo the surgery, participants suggested at a meeting of the New York Committee on Quality Improvement in Living Liver Donation.

New York State Health Commissioner Antonia Novello appointed the advisory panel in March after issuing a highly critical report on the death of liver donor Michael Hurewitz, 57, at Mount Sinai Hospital (see earlier Transplant Week story).

The panel -- charged with looking at ways to ensure the donor understands what the risks are and ways to ensure the best donor care -- is expected to have draft recommendations by its next meeting in Albany October 24th.

While discussion of the "donor advocacy" teams remained at a preliminary stage, panel members stressed the need to better help would-be donors focus not on the life they hope to save, but on the risk they personally face.

"There has to be some group whose interests are just with the donor," Dr. Francis Delmonico, professor of surgery at Harvard Medical School, said. "This advocate team must have an interest that is particular to that donor alone."

Instead of referring to the agreement of a person to be a donor as "informed consent," panel members suggested calling the process "informed choice," which doesn't presuppose the giving of consent.

"To call it informed consent loads the process from the outset," said Dubler. "The emphasis should be on the risks."

Delmonico said the New York panel's recommendation "will have an impact" on the discussions of a federal advisory panel to Health and Human Services Secretary Tommy Thompson which is considering some of the same issues.