Season 2 Episode 51: Before Crisis Hits: The Organ Donation Conversation Every Family Needs

Originally published as Episode 51 of Thoughtful Planning Podcast

Picture this: Your child is in the hospital, declared brain dead. The doctor says according to their driver's license, they're an organ donor. But you've never talked about this as a family. In your grief and shock, what would you say?

This exact scenario recently played out on HBO Max's series "The Pitt," and it made us realize how one difficult conversation could help families navigate these devastating moments with more clarity and less confusion.

A Wake-Up Call from "The Pitt"

We recently finished watching HBO Max's "The Pitt" – and fair warning, it's incredibly graphic and meant for adults only. You definitely don't want to be eating dinner while watching. But it's remarkably realistic in showing what happens in emergency rooms.

Season one follows one shift in the ER, where doctors and families face impossible decisions. One storyline that particularly struck us involves a 19-year-old college student living at home. His mother found him unresponsive in his bed after he overdosed on Xanax laced with fentanyl.

Despite every possible test and intervention, the young man was declared brain dead. When the transplant coordinator met with the family, they learned their son was a registered organ donor according to his driver's license.

The mother's immediate response? No. She was upset and overwhelmed which anyone can understand. You're already dealing with the worst possible news about your child, and suddenly you're asked to make this enormous decision while grieving and in shock.

Eventually, the parents agreed to organ donation, and the series shows a beautiful "honor walk" where hospital staff and the son's college friends line the hallway to honor his decision and legacy.

But imagine if that family had talked about this beforehand. If the son had been able to say, "If something like this ever happens, this is what I want." The outcome might have been the same, but the journey could have been easier for everyone involved.

The Legal Reality of Organ Donation

Here's what we learned about how organ donation actually works:

If someone is registered as an organ donor: The family is informed of that decision rather than asked for permission. Under the Uniform Anatomical Gift Act (UAGA), which most states have adopted, this is called "first-person authorization" which is a legally binding decision that family members don't have legal authority to revoke.

If someone isn't registered: The family does get asked to make that choice.

The complication: Studies show that families often don't even know their loved one registered as a donor. Even when someone is registered, organ procurement organizations sometimes defer to family wishes because of the emotional timing.

It's worth noting that Arkansas recently passed in 2025 an amendment allowing next of kin to prevent organ donation even if someone registered as a donor which shows these laws continue to evolve.

Why the Conversation Matters More Than Paperwork

Regardless of legal documentation, having that conversation beforehand is what prevents families from being blindsided and having to guess what their loved one would want.

The conversation isn't about convincing anyone to become an organ donor or not. Some people choose not to be organ donors for various personal reasons, and that's completely okay. The point is that everyone gets to express their wishes clearly so their family knows how to proceed.

How to Start This Difficult Conversation

We're thinking one way to approach this might be watching a show like "The Pitt" as a family (again, adults only because of the content) and using it as a starting point.

After each episode, you could pause and ask, "What would you want in this situation?" Let everyone take a turn speaking. There's no judgment, you're just listening.

Another perfect opportunity is when your child is getting their driver's license for the first time. Explain all the choices they're making and how important they are. This is a significant responsibility and a natural time to discuss these decisions.

Document Your Decisions

Once you've had these conversations, we highly recommend documenting them:

• Register as an organ donor through the Department of Motor Vehicles when you get your driver's license
• If you prefer privacy, include your wishes in your advance directives
• Make sure everyone knows your decision so they don't have to guess during an incredibly difficult moment

Learning from Others' Experiences

We've talked about organ donation before with some amazing guests who can provide additional perspectives:

• Episode 9: Rachel Quigley from Texas Organ Sharing Alliance walked us through the entire process: https://youtu.be/Br6EfLJCX7U
• Episode 10: Kim Perkins, who received a pancreas from a young man and meets with his mother every year to celebrate life: https://youtu.be/XmPIyUE5kyE
• Episode 41: Dr. Brittany Clayborne and her son Micah, both heart transplant recipients who started Transplant Teenz to help other teens navigate the experience: https://youtu.be/9pWuP1CyWXk?si=tykvwK3X5b6dJlDw

Your Next Step

Here's our call to action: Pick a way to start this conversation with your family. Whether it's watching "The Pitt" together, discussing it during driver's license time, or just sitting down for an honest family discussion. Please have the conversation.

If you have questions, reach out to us at [email protected], talk to your doctor, or consult with an estate attorney or other professional who can help.

Your family will thank you for removing the guesswork from an already devastating situation.

The Essential Question

What are your wishes for organ donation? And have you shared those wishes with your family?

This is a hard topic, but it's incredibly important. Remember, every chapter you write today shapes your legacy tomorrow.

Thoughtful Planning helps families navigate life's biggest moments without feeling overwhelmed. Listen to more episodes on your favorite podcast platform by searching "Thoughtful Planning."