Bodies, organs and saving lives: the alternatives

Abstract

-In a paper in the last issue of Clinical Medicine, 1 some of the background to attitudes to newly dead bodies, the current context of an urgent need for organs for transplant and the objections to calling a proposal to address this 'presumed consent' were outlined. Here further concerns are explored.

Remapping the organ donation ethical climate: a care ethics consideration

“…A presumed consent model is a primarily favoured approach despite the entrenched altruistic notion of gift of life; thus raising questions regarding the authenticity of such donations (Guttman et al, 2016). Notwithstanding its appeal, it is far from ethically unproblematic and rife with criticisms, notably on its effectiveness in overcoming organ shortage (Albertsen 2018;Hawkes 2018;Dalen and Henkens 2014;Saunders 2010;Verheijde et al, 2009;Bilgel 2013). Critics often point to considerably long transplant waiting lists in presumed consent jurisdictions, citing that legislation alone would not increase donor rates (Shepherd et al, 2014) while other objections include the lack of trust and certainty in such systems (McCartney 2017).…”

What are the issues in organ donation in 2012?

“…More recently, the ethics committee of the Royal College of Physicians of London has called for an examination of mandated choice in the UK. 4 Presumed consent or mandated choice might seem attractive options to increase the numbers on the ODR, but run the potential risk that 'the State' is perceived as bullying, or even dictating that ownership of one's organs ceases after death. The current system of voluntary sign up to the ODR is viewed by many donors and relatives as a positive decision which can help them take something positive out of a tragedy.…”

“…In the UK, a Conference of the Medical Royal Colleges and their faculties produced guidance for the diagnosis of brain (stem) death in 1976 3 and, in a subsequent memorandum 3 yr later, equated brain death with death of the whole person for the first time. 4 In the USA, the 1981 Uniform Determination of Death Act (UDDA) gave equivalence to death determined by neurological and cardiovascular criteria, although it did not mandate a standard by which brain death should be determined, confirming only that this should be in accordance with accepted medical standards. 5 There is broad consensus, particularly in Western cultures, that human death is ultimately death of the brain and that this crucially involves the irreversible loss of the capacity for consciousness, combined with the irreversible loss of the capacity to breathe.…”

Mandated Consent – Not a Viable Solution for Organ Transplant in Singapore

“…A third option of designating the decision to a family member is considered by many to be helpful. 14,15 The task chosen should be inclusive in order to reach a maximum number of potential donors. The process must fulfill the requirements of informed consent, where individuals must be able to register their choice in an environment conducive to communication and contemplation.…”