Organ Donor Dilemmas: Pregnancy, Policy and Practical Implications

Research regarding organ donors who are pregnant at the time of death is extremely limited. Organ Procurement Organizations (OPO) responses to these donors is not widely understood, particularly in states with restrictive abortion laws post Dobbs decision of 2022. In an IRB exempt, qualitative study, we invited 25 OPOs from abortion restrictive states and 2 OPOs from non-restrictive states to participate in a confidential survey regarding management of potentially pregnant and deceased organ donors. The electronic survey inquired about jurisdiction and OPO demographics, OPO’s process for handling pregnant and deceased donors, communications with external parties, and relevant laws and policies at the state and OPO level. We received completed surveys from 5 OPOs in abortion restricted states, and one completed survey from an OPO in a non-restricted state. 4/5 restricted OPOs did not have data on the number of pregnant donors they have been presented with in the past three years. None of the restricted OPOs have an official policy in place to handle such cases. The non-restricted OPO shared their specific policy for management of pregnant donors, which includes ethics and medical consults. The OPO comes forward for donation only after a separate decision is made regarding the life of the fetus, irrespective of donation. The combination of the Dobbs decision and the current pressures that OPOs are under regarding resource allocation had a significant impact on OPOs’ willingness to create and discuss policies regarding pregnant donors. Restrictive abortion laws have a chilling effect on OPOs even addressing the issue of organ procurement from potentially pregnant donors as evident in reasons cited for choosing not to participate, for example, stated discomfort with questions being asked and denial to participate per executive leadership. A transparent and proactive policy regarding pregnant organ donors could mitigate potential legal issues and overall discomfort for OPOs that are already under an exorbitant amount of pressure to save as many lives as possible, honor the deceased, and avoid legal repercussions.