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Morticians balk at organ donations

Monday, March 27, 2000

By Christopher Snowbeck, Post-Gazette Staff Writer

One of the last open pockets of resistance to organ donations is coming from a group that deals with the families of donors as much as hospitals do -- funeral directors.

Some funeral directors here and elsewhere in the nation believe organ recovery teams mutilate donors' bodies and make it harder for them to prepare bodies for viewing.

It's an argument that may have more emotion than fact attached to it, but it's a real phenomenon that could influence some people not to sign up as organ donors.

Because of that, many organ recovery groups, including the Center for Organ Recovery and Education here, are beginning to offer modest payments to funeral homes for any extra work they have to perform to prepare donors' bodies for viewing.

CORE is not the first organ procurement organization to offer funeral homes such a payment, but its decision to do so comes at a time when national organizations are working to develop a "best practices" document to guide groups that recover bones, corneas and other tissues from donor bodies. That's because funeral directors are concerned that too many bodies are dealt with in a way that makes the job of preparing a body for visitation particularly difficult.

It's a rift that can have painful ramifications when families that agree to donate get caught in the middle.

Ralph Guzzo Sr. donated his 19-month-old son's organs in 1998 and the Monongahela man has nursed a burning anger against CORE ever since. Part of the reason is that Guzzo heard from Timothy Billick, the funeral director who prepared the boy's body for a viewing, that CORE's practices had been disrespectful to donor bodies in the past and that something similar could happen to Guzzo's son Ralph.

Billick said that in the Guzzos' case, he didn't end up having a problem preparing Ralph Jr.'s body for viewing, but he did recall warning the family that he couldn't guarantee an open-casket ceremony until he saw the body.

Billick said he often calls families to tell them his feelings about the organ recovery process so they have the chance to change their minds about donating.

"I believe that CORE paints a pretty picture as far as being able to help someone else, but when people sign off to either be a bone donor, tissue donor, whatever, the average person has no idea what CORE does," Billick said. "If the average person knew what type of procedure was used on their loved one, I'm sure that a lot would make a decision not to donate."

Brian Broznick, the executive director of CORE, said his organization's employees always tell families exactly what happens in recovering organs, and in the case of bone donations, how the recovery team makes an incision from hip to ankle to remove leg bones and then replaces them with piping so there's no deformity.

With organ donation, there's an incision from neck to waist through which the organs are removed. Often, families say they don't want to hear the details, Broznick said, and families often don't remember much of what is said during a conversation at the hospital about donation, because they are still in shock.

"I don't know where's that fine line -- telling people too much where you're actually upsetting them," Broznick said. "I don't know where you stop, but we try to explain as much as we can without causing the family any more difficulty."

Although Broznick was unaware of other funeral directors engaging in Billick's practice of calling donor families at the hospital to give graphic information about the recovery process, he said he knows of cases in which funeral directors talked families out of donating once the families visited the funeral homes.

Such conversations can occur early enough to prevent organ donations because the family member may be brain-dead but is still on life support.

In Guzzo's case, for example, Billick said he told Guzzo his son's life support had not been turned off yet, which also upset the father.

CORE acknowledges that funeral directors must spend more time working on a donor.

To make sure that families never get billed for that time, the new CORE program offers a $150 payment to a funeral home that has had to do extra work on a donor. CORE implemented the program in February after studying the results of a survey it issued to 2,000 funeral directors last year.

The idea for the survey came from James Lowery, a funeral home operator in Charleston, W. Va., who was the first funeral home representative on the board of directors at CORE. Lowery expressed to board members concerns he had heard from funeral directors.

To get the fee, funeral directors must give CORE a form that has a place for comments and concerns, which should improve communication, Broznick said.

Some extra work

Why do funeral directors have to spend more time on organ and tissue donors' bodies?

When corneas are taken, there can be bruising around the eyes. When the bones of the leg are donated, the circulatory system that embalmers use to preserve bodies can be damaged. That means the embalming fluid can leak.

Funeral directors also get upset sometimes if the organ recovery takes longer than expected and interferes with scheduling of viewing and funeral services.

Some funeral industry officials use strong language in talking about these problems.

"They pretty much terrorize the body without much regard for the fact that the funeral director has to take that body and prepare it for a viewing," said John Fitch, legislative director of the National Funeral Directors Association.

Fitch's group has met with the American Association of Tissue Banks to develop a "best practices document" so that the groups can work together better.

A lot of the problems could be resolved if the recovery teams used proper techniques, he said.

Funeral directors generally don't get compensated for the extra time they spend on donor bodies, Fitch said, and they are concerned that federal efforts to boost donation will make that situation worse.

Many local funeral directors, however, say they welcome more donations.

"From my experience, I would say that's an isolated situation," Patrick Lanigan, a funeral director in East Pittsburgh, said of the Guzzo story. "I think funeral directors in general have a concern about receiving the body in a condition that makes it difficult for embalming, preservation and presentation to the family. It does require more work. . . . My personal belief is, it's a small price to pay."

Lanigan, the past president of the Allegheny County Funeral Directors Association, said that sometimes donors must be put in plastic suits that prevent leaks before they are dressed in their clothes. The plastic suits can give the bodies a different look.

Funeral directors who are ambivalent about donation should have a new reason to reconsider their position, Lanigan said.

Just this month, Lois Gibson, a North Versailles woman who works for the state issuing death certificates, received a life-saving kidney transplant from Emil Sanielevici, the 20-year-old University of Pittsburgh student killed in the Wilkinsburg shooting rampage March 1. Because of her job, Gibson is in close contact with many funeral directors.

"If they know Lois and they had a bad opinion about organ donation, they would change their mind knowing that she received a kidney," Lanigan said.

Resistance scattered

Jim Hahn, the immediate past president of the Pennsylvania Funeral Directors Association and owner of three funeral homes, said that donors who are kept on life support can swell up, which, in turn, is sometimes blamed on a funeral director.

"We're judged by that all the time and a lot of times people don't realize that things happen that are out of our hands," Hahn said.

Hahn, who supports organ donation, said some complaints about CORE come from older funeral directors who haven't had much experience working on organ donors.

There also could be pockets of resistance in small communities.

One funeral director in Monongahela who asked not to be identified said he believed several funeral directors in the Mon Valley share his negative views about CORE. The funeral director acknowledged, however, that if he or a loved one needed an organ for transplant, he would hope for a donor.

"I personally don't like CORE," the funeral director said. "I will never become a donor. I just believe I came with everything, I'm leaving with everything. . . . It could be viewed as mutilation."

The anti-donation attitudes of some funeral directors in the southwestern part of the state could partly explain the relatively low rate at which residents in Washington, Fayette and Greene counties have listed themselves as organ donors on their driver licenses, Broznick said. A state report in October found that of the 66 counties in the state, Washington, Fayette and Greene ranked 55, 64 and 65 respectively in the percentage of drivers who list themselves as donors.

Just as funeral directors feel they get unfairly blamed for the appearance of a body in some cases, organ procurement groups say the same can happen to them, Broznick said, when embalmers do a poor job.

When CORE learns that a funeral director has problems with donation, someone from the organization tries to meet face-to-face to discuss the issue.

Some funeral directors refuse to do so, Broznick said.

As for the complaint that organ recovery officials don't tell families what happens to the body during organ retrieval, Broznick said he doubts funeral directors tell families exactly what goes on during embalming, either.

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