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In Reply: The number of organs needed for individuals on organ donation waiting lists continues to exceed the number available. In our article, we considered the possibility of addressing this gap by allowing surrogates to donate the organs of patients who have been declared to be in persistent or permanent vegetative state (PVS). We argued that this proposal has the potential for errors that could undermine public support for organ donation, while yielding a modest number of organs.

Current diagnosis of PVS is characterized, as Dr Schears notes, by "well-documented cases of mistaken diagnoses, confusion in terminology, and inadequate observation of patients." We support the call by Schears for increased research to improve diagnosis of PVS. Additionally, current data suggest that surrogates often are unable to predict the choices incompetent patients would have made if competent.^1-3 In response, Schears calls for increased education of surrogates. Because individuals are unlikely to . . . [Full Text of this Article]

David Wendler, PhD
dwendler@nih.gov

Ezekiel Emanuel, MD, PhD
Department of Clinical Bioethics
National Institutes of Health
Bethesda, Md

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