April 12, 1997 2:35 AM

I am sitting in the ICU resident's office at San Francisco General Hospital typing this journal entry. Right now about 15 feet away, a family has gathered to weep over the dying body of their eldest son.

Two hours ago, an unknown 30-odd year old man was brought in to the ER with severe head injuries. Brain was literally pouring out of the right side of his head and blood was pumping out of his nose and mouth and slowly seeping out of his ears. He was brought to the unit for "stabilization" as a potential organ donor. The chief residents in neurosurgery and trauma and I pumped blood, plasma, fluids and pressors into him in a vain attempt to keep him alive until the family could be found and permission could be obtained for organ donation.

We finally came upon the family too late. He was in florid DIC and the futility of the situation was crystal clear. Due to the severity of his condition, his organs were no longer "usable". We stopped the resuscitation just as the family arrived at the bedside.

The blood pressure is now 49/22 and the heart rate is 165. Death is only a few minutes away.

I have always been uncomfortable with the concept of organ donation. Invariably, the donor is a previously healthy young person who suffers a catastrophic event, be it a cerebral aneurysm or a motorcycle accident or a severe head injury. The diagnosis of brain death is clearly established (absence of brainstem reflexes, apnea, etc.) and then the "organ procurement team" approaches the family about organ donation. If the patient has previously documented his wishes to donate organs (for example, by registering as a donor with the department of motor vehicles), the family can be bypassed. If the patient has not expressed wishes, it is the family's decision whether or not to donate organs. I have never been able to say " your son is

Personally, I am not an organ donor. I do not wish my body to be kept alive and to undergo a "harvesting procedure" upon death of my brain. If this sounds selfish coming from a physician, so be it. Perhaps it is a sense that I have given enough of my self to the sick already. Or, maybe it's the encounters I have had with some organ recipients : the dreadful alcoholic given a liver, the noncompliant diabetic given a kidney, the obese smoker with a new heart, the lung recipient who spent three months intubated in the ICU with sepsis and respiratory failure before a pulmonary embolus mercifully took her life.

My reasons for not being an organ donor are very personal. I do not wish to justify them to anyone. That means I don't want any fucking e-mail about how miserable a human being I am.