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October 27, 1993

Voluntary Organ Donation: Autonomy... Tragedy

JAMA. 1993;270(16):1930. doi:10.1001/jama.1993.03510160048014

To the Editor.  —Younger and Arnold1 missed an important point in their defense of the University of Pittsburgh (PA) Medical Center (UPMC) organ harvesting protocol. While the UPMC protocol elaborately dances around societal constraints on organ donation, it still bows to the unreasonable requirement to get relatives' permission for the donation. This perpetuates relatives' unconscionable role in trumping a deceased patient's autonomy.2 Despite explicit instructions, often in writing on a donor card, no US organ procurement organization will harvest organs or tissues without explicit permission or statutory authority.3 Yet this behavior nullifies the individual autonomy to which medical professionals and members of society subscribe—for the living (eg, informed consent), the nearly or eerily dead (eg, advance directives), and the clearly dead (eg, wills).4Despite its problems, the UPMC protocol's multiple constraints do little to avoid burying or cremating the tens of thousands of usable organs whose