Becoming A Donor

How to Donate

Next time you're at the Department of Motor Vehicles office in any California city, check out the white donor cards with pink, peel-off stickers, known as a donor dots.

"If you wish to make a donation, fill out this card and put the DONOR dot on the front of your license or I.D. card next to the photo where indicated," the instructions read. "This is a legally binding document."

The card and the pink dot give you the power to donate the organs, tissues or parts you specify. Donor cards are the result of the Uniform Anatomical Gift Act of 1968.

The Anatomical Gift Act permits physicians to remove organs and/or tissue after the death of a person who signed a donor card. It has been adopted in some form in every state. Filling out the card doesn't enter your name in any national database - it mainly will alert medical personnel to your wish to be a donor.

But even if you don't sign or keep a donor card or place a donor dot on your identification or driver's license, your organs and tissue may still be donated when you die. For instance, if you tell your family you want your body parts to be donated, they may give that information to medical personnel, who will decide if your remains are medically suitable. Or, even if you never spoke about organ donation to anyone, when you die, your family may still decide to donate your remains. A donor may also make anatomical donation a provision in a will. However, this is not the best place to make your wishes known, since the terms of the will may not be revealed immediately after death.

In California, there is no state registry for donors, so in the event of death, families and the medical community rely on donor cards and donor dots to understand the intent of the deceased. Arkansas, Colorado, Iowa, Louisiana and a number of other states have donor registries, says Anne Paschke, spokesperson for the United Network for Organ Sharing.

Why People Say No

There are many reasons people choose not to donate.

Some of those reasons include:

Religious beliefs, which include the desire to be reincarnated with the whole body intact.
Squeamishness at the thought of having organs and tissue removed.
Belief that doctors will not work hard to save the life of a donor.

"The way I look at it, people don't donate... because they don't know enough about it," says Dr. Nicolas Jabbour, associate director of liver transplant surgery at the University of Southern California, who gives lectures to students and community organizations about donation.
"They never talk about it, they don't even consider it. And the worst time to approach a family is after a disaster happens," Jabbour says.

Nearly two-thirds of Americans who sign organ donation cards will not have their wishes honored at the time of death, largely because family members object to the deceased's intent and medical personnel are unable to proceed, according to an American Kidney Fund Web site bulletin.

"Even if a patient is carrying a donor card, California Transplant Donor Network (the designated organ procurement organization in Northern California) will not proceed if the legal next of kin or family says no," says Vivian Brailoff, director of critical care services at John Muir Hospital in Walnut Creek, CA.

Technically, a donor card and dot have legal clout, but organ procurement organizations will not rely only on that legal authority, Brailoff says.

"For reasons of public acceptance of organ and tissue donation, it is important that CTDN respect the wishes of the living," Brailoff says. "That is why it is so important for people to tell their families what their wishes are. And family members, while perhaps not wanting donation for themselves, need to consider the importance of honoring the wishes of the deceased."

Because of the desire to get family consent, a "Get the Word Out" sentiment is common among advocates and members of the medical community. In brochures, public speeches and radio advertisements, donation advocates encourage people to tell their families about their wish to donate. Recently, basketball player Michael Jordan appeared in an advertising campaign to encourage people to talk about donation. In California and some other states, discussing your wishes to donate is crucial because procurement organizations seek families' consent before proceeding with organ and tissue recovery.

In April 2002, Iowa Governor Tom Vilsak signed the First Person Consent Bill, which is "meant to remedy a significant barrier to organ transplants," according to the American Kidney Fund Web site. The bill states that only the donor can revoke or supercede a document of gift, such as a donor card. State registries and bills like the one passed in Iowa make it difficult for family members opposed to donation to hinder the organ and tissue recovery process. When donors' wishes are met, more organs and tissue are recovered, and more people's lives can potentially be saved.

However, there also is the possibility that a person's organs will be rejected for medical reasons.

Before organs are removed, hospital staff will run a series of tests on the potential donor for HIV, hepatitis and other diseases and infections that could be transmitted to a transplant recipient.

For this reason, health care and procurement organization workers consider people who have signed up via the DMV dot program as only "potential" donors, who ultimately may not be able to provide any organs after the final medical screening and testing procedures are conducted.

It is difficult to say how many people in California carry donor cards or place donor dots on their licenses or identification cards. DMV gives a donor card to every person seeking driver's licenses or identification, but people choosing donation never reply back to DMV about their decision. The card and dot are only good for medical reference. In 2002, there were 22,605,810 people carrying driver's licenses and 3,984,579 people carrying identification cards, according to DMV statistics.

California Transplant Donor Network estimates that each year, about 15,000 people die nation-wide under conditions that make them medically suitable for organ donation. In 2001, only 6,081, or a little more than one-third of those people were organ donors. That compares with the 81,422 candidates on the national waiting list for organ transplants as of May 5, 2003