Chapter 26: The Ethics of Organ Transplant

ETHICAL PRINCIPLES

Autonomy

• Donor: Does he or she really want to be a donor?

• Recipient: Does he or she actually want a transplant?

• Types of consent:

  • Informed consent

    • Opt-in: Registering with the organ registry of the state prior to illness or injury.

    • The donor if he or she is a competent adult or emancipated minor.

    • Authorized to apply for a driver’s license as long as the donor is of statutory age to apply for any type of driver’s license.

    • An agent of the donor unless the power of attorney for health care or other record prohibits the agent from making an anatomic gift.

    • The parent of an unemancipated minor.

    • The donor’s guardian.

• The manner of making an anatomic gift before the death of the donor:

  • The donor may authorize a statement or symbol indicating that he or she has made an anatomic gift to be imprinted on the donor’s driver’s license or ID card.

  • In a will.

  • During a terminal illness or injury, by any form of communication that is addressed to at least 2 adults. One of the witnesses must be disinterested.

  • As provided by statute: (1) the donor or other person authorized to make an anatomic gift, be it by donor card or other record that has been signed by one of the parties; (2) a statement or symbol of the anatomic gift in the donor registry. If it cannot be signed by the donor or other authorized person, it may be signed at the direction of either of the parties and must (1) be witnessed by at least 2 adults, at least one of whom is a disinterested witness who has signed at the request of the consenting party; (2) state that it has been signed and witnessed as in (1).

  • Revocation, suspension, expiration, or cancellation of the donor’s driver’s license or identification card, which is the basis for the anatomic gift, does not invalidate the gift.

  • An anatomic gift made by will takes effect upon the donor’s death whether or not the will has been probated.

  • Invalidation of the will after the donor’s death does not invalidate the donor’s gift.

• Uncontrolled donation after circulatory death (uDCD: an out-of-hospital cardiopulmonary arrest with no return of spontaneous circulation)

  • The informed consent conversation in the field takes place over a short period, usually under substantial emotional distress.

  • uDCD is consistent where the presumed donors have made a prior articulated gift by signing their driver’s licenses or enrolling in the state registry or by making a disposition in a will.

• Presumed consent.

  • Opt In: Provides that each person is an organ donor. It requires that members of society knowingly refuse to be donors.

    • uDCD is ethically permissible under a presumed consent system because all members of society are on notice that they are potential organ donors.

    • It permits enhanced recovery of organs for transplant (see “Social Justice”).

  • There is the potential to diminish societal trust in the ...