Preserving trust in organ procurement.

Physicians know that it rarely makes sense to conceal a discouraging diagnosis from a patient or to sweep a bad prognosis under the rug. Doing so compromises the trust that secures the doctor-patient relationship.

Unfortunately, some people in the transplant community don't seem to understand that without similar openness, the social contract that forms the heart of the organ donation process can be compromised.

I'm the CEO of OneLegacy, the nation's largest organ procurement organization (OPO), serving 18 million people in Southern California. During the past 2 years, the state of California has been rocked by no fewer than five scandals involving organ procurement or transplant. Physicians may find these cases--and how we responded to them--to be instructive.

* In September 2005, the Los Angeles Times reported that the liver transplant unit at St. Vincent's Hospital in Los Angeles accepted a donor liver for one patient, but ended up transplanting it into another patient ranked 52nd on the waiting list. Coincidentally or not, that patient's fees were being paid in full by the Royal Embassy of Saudi Arabia. Hospital staffers repeatedly falsified documents in an attempt to cover up the incident.

* Several months later, local news media reported problems of inadequate staffing at the University of California, Irvine (UCI), liver transplant unit. The program had been performing few transplants, and had been declining offers of donated livers. Patients remained on the waiting list longer than they should have, and some died before receiving an organ.

* Kaiser Permanente-San Francisco Medical Center (KPSFMC), which had previously referred its kidney transplant patients to other hospitals, decided to start its own kidney transplant unit. Staffing problems caused patients to be passed over when organs became available.

* In San Luis Obispo, a physician charged with procuring a patient's organs participated in ordering that patient's pain medication and sedatives prior to his death, and had participated in the declaration of death. This is a fundamental violation of transplant rules and ethics.

* In Southern California, two patients developed Chagas disease shortly after receiving donated organs. Until recently, we didn't screen donor organs for the presence of the parasite.

There were dire predictions that the bad publicity would result in decreased organ donations. In fact, the number of organ donors actually rose by 16% in 2006, setting a national record with 432 organ donors and 1,338 lives saved.

How do we account for this record-breaking performance in the light of all the problematic news? One word: openness.

Some counseled us at OneLegacy to avoid the press, but we chose to seek out press coverage to point out that these scandals were aberrant events. We chose to be entirely open and transparent.

We explained that the St. Vincent's story involved one patient in one hospital. The UCI story involved a small transplant unit and a small number of patients; whether they would have received transplants given more substantial staffing at the center is unclear. The San Luis Obispo story got attention precisely because it was a rare event.

In the Chagas incident, after the Food and Drug Administration approved a screening test for Chagas disease this January, we became the first OPO in the country to adopt the test.

When we're open and honest, people realize that the number of ethical and safety problems in this field is minuscule. This is the most well-documented field of medicine that has ever existed. From the moment a person is listed for transplant to the moment that they die, they're tracked on a regular basis. On the donor side, the entire consent histories are maintained on every transplant, so there's a wealth of information that allows us to ensure that the system works remarkably well, and that these unfortunate cases exceptions are, truly, exceptions.

Physicians enjoy a wonderful bond of trust with their patients. When discussing transplantation and donation with your patients and families, I hope your openness and honesty inspire their confidence and desire to give greater meaning to their lives by giving the gift of life.

TOM MONE is Chief Executive Officer of OneLegacy, a federally designated, nonprofit organ procurement organization serving the greater Los Angeles area.