Organ and Tissue Donation
AUTONOMY OF THE DONOR
Organ and tissue donation is a voluntary event entirely at the discretion of the live donor.
The principle of autonomy is fully in play here.
For example, a 35-year-old-man is dying of hepatic failure. His brother is fully
HLA matched and a highly compatible donor. There are no other donors at this time
and the patient will likely not survive long enough to find another donor. You are
screening the brother for the donation, but he is not willing to undergo the surgery for
the partial donation. What should you do?
There is nothing you or anyone—including a court of law—can do to compel a person to
donate an organ or tissue if he clearly chooses not to do so. The need of the recipient has no
impact on mandating a donor to donate. This is true even if the donation is uncomplicated for
the donor and the recipient will die without it.
ORGAN DONOR NETWORK ASKS FOR CONSENT FOR DONATION
For example, a 30-year-old woman is your patient in the intensive care unit for
respiratory failure. The patient has had a motor vehicle accident and has sustained a
massive intracranial hemorrhage. The patient is brain dead and will be removed from
the ventilator. You know that there are numerous patients in your hospital waiting for
organs. The family of the patient is with you. You have an excellent relationship with
the family and they trust you. What should you do about the donation?
Only the organ donor network or uniform network for organ sharing should obtain
consent for an organ donation. The medical team taking care of the patient should not ask for
the donation. Even if your relationship with the family is excellent, the organ donor network
has an enormously greater success rate in obtaining consent. Physicians that ask for consent
for organ donation are far more likely to be refused. Because a. greater number of refusals
would lead to a loss of potential organs for donation when the shortage statute of available
organs is critical, it is against the law for doctors to obtain this consent. By legal statute, only
those specifically trained to obtain consent for organ donation should approach the family for
this consent.
In addition, there is the perception of an enormous conflict of interest on the part of the
family when a caregiver attempts to obtain consent. When a caregiver asks for consent, it
leads some families to believe that the health-care team is not doing everything possible to
preserve the life of the patient. This makes it seem that the priority of the health-care team is
to obtain organs. It is essential for the health-care team to preserve its relationship with the
family as the advocates for preserving the life of the patient. In addition, the organ donation
network has a much greater chance of obtaining consent, so if the primary health-care team
tries to obtain consent, it could lead to a loss of needed organs.
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PAYMENT FOR DONATIONS
With the exception of renewable tissues such as sperm, unfertilized eggs, and blood,
payment for organs is considered ethically unacceptable. People must not be in the business
of selling organs. The economic aspects of organ donation must be minimized so that people
believe that the patients who need organs the most will get them, not that the wealthy will get
preferential treatment. It is, however, acceptable to cover the cost to the donor of donation.
There is a difference between reimbursing the donor for the cost of donation and creating a
financial incentive for people to “sell” organs.
ORGAN DONOR CARDS
Although an organ donor card gives an indication of a patient’s wishes for donation,
family consent is still necessary for donation. Family objection can overrule the organ donor
card.