28 Jan Ask Alice February 2021

Dear Readers,

I have an auspicious ADDENDUM/CORRECTION to last month’s column on green burials. Based on several on-line listings of green burial sites, I said in that column that the only green cemetery in southeast Vermont seemed to be Meeting House Hill Cemetery on Orchard Street. But almost immediately, I received an email from Barry Aleshnick with the Board of Trustees of Christ Church Cemetery Association, letting me know that they have been a hybrid cemetery allowing green burials since January 2020. Christ Church Cemetery is on Rte. 5 and Melendy Hill Rd. in Guilford, and is open to anyone in the community, regardless of affiliation. Moreover, my friend who is on Guilford’s town cemetery commission told me most of their cemeteries also allow green burials.

Beyond these specific omissions, I think this feedback suggests that the availability of locations for green burials is rapidly increasing and the on-line listings are not complete — so if you have a cemetery you are interested in and want to have a green burial, you may want to just ask them about it.
Thanks, Alice

Dear Alice,
I am looking through the VT short form Advance Directive (AD), and see the question about being an organ donor. What can you tell me about the effect of saying in my AD that I want to be an organ donor? Does it make sense to say I want to be an organ donor if I am also saying I don’t want my life extended by machines and want to die at home if possible?
Thanks for your help, Thinking About Organ Donation

Dear Thinking About Organ Donation,
Organ transplantation has been an amazing step forward in the history of medicine, offering patients a new chance at healthy, productive, and normal life. Transplants rely on the generosity of donors, however, and there are not enough donors to meet the need. According to Donate Life New England, most Americans “support donation as an opportunity to let their organs and tissue give life and health to others when they no longer need them,” but nonetheless fail to register as a donor.

As you noticed, the VT short form Advance Directive has a section addressing organ and tissue donation. The advance care planning (ACP) process is a good context in which to think about organ donation, and your Advance Directive is a good way to let your agent and other loved ones know how you feel about it. However, stating your wish to be an organ donor in your AD is not the same as registering to be an organ donor. If a potential donor is not in the organ donor registry, even if they have indicated a desire to be an organ donor in their Advance Directive, their family will be contacted to authorize the donation and complete the screening questions. Thus, while stating your desire to be an organ donor in your AD will make the decision easier for your family, you should probably go ahead and register to be an organ donor if you want to totally remove the burden of the decision from your family and allow the whole transplantation process to work more quickly and smoothly. You can register online at DonateLifeNewEngland.org. You can also sign up to be a donor with the VT Department of Motor Vehicles when you get or renew your license, and this will automatically enroll you in the Donate Life New England Registry. It is very important to make sure that your license and your AD reflect the same wishes about organ donation (i.e., if “Donor” is on your license, your AD should indicate that you wish to donate).

Your second question, about the seeming inconsistency of your desires to be an organ donor but also to avoid machines and die at home if possible, is an interesting one. And like so many interesting questions, the short answer is “it depends.” For most people, these two desires can co-exist, but in different end-of-life scenarios – and at the time we do our AD (or register to be an organ donor), we don’t know which will apply.

One of the reasons there is such a shortage of donated organs is that even if a person is registered as a donor, they must die in very specific circumstances to actually become a donor. They will have suffered an accident or illness (e.g., a head trauma or a stroke), and will be in a hospital where they were put on mechanical/artificial support but nonetheless died. Only then can organ donation become a possibility; otherwise, the person’s status as an organ donor or a family’s authorization for organ donation just doesn’t come into play. See www.organdonor.gov/about/process/deceased-donation.
Thus, if you have a DNR/COLST in which you specify you do not want any mechanical/artificial support under any circumstances, then it does not make sense to contemplate organ donation. But for those of us who can imagine scenarios in which we would accept mechanical/artificial support for at least a short period to see if we recover (or in which we might end up on mechanical/artificial support in an emergency situation anyway, because we don’t have a DNR/COLST), it certainly can make perfect sense to sign up to be an organ donor – even if we would choose to die at home, without machines, under other circumstances.

I hope this helps. For more information, I recommend www.donatelifenewengland.org, and www.organdonor.gov.

Best wishes, Alice

As always, please contact Don Freeman, Taking Steps Brattleboro Coordinator, 802-257-0775, ext. 101, or don.freeman@brattleborohospice.org, for information about Advance Care Planning.

Till next month, folks. Please send your questions to Alice via info@brattleborohospice.org.