Organs and organisations: Situating ethics in organ donation after circulatory death in the UK

Abstract

Controlled organ donation after circulatory death (DCD) has recently been revived in the UK, as part of attempts to increase organ donation rates. The re-introduction of DCD has subsequently become the focus of bioethical controversy, since it necessitates intervening in the care of dying patients to obtain quality donor organs. Transplant policy responses to these concerns have generated new legal and ethical guidelines to address uncertainties around DCD, producing claims that the UK has overcome' the ethical challenge of DCD. In contrast, by drawing on Lynch's call to 'respecify' ethics, this paper argues that ethics in DCD cannot be reduced to abstract directives for practice, but, instead, are composed and dealt with as an organisational problem. To do this, I utilise data from an ethnographic study examining the production of the 'minority ethnic organ donor' within UK organ donation settings; in particular, the data pertains to a case hospital which was in the process of developing a DCD programme during the period of fieldwork. Findings show that the ethics of DCD are encountered as practical sets of problems, constructed in relation to particular institutional locales. I describe how these issues are worked-around by creating conditions to make DCD organisationally possible, and through the animation of standard procedures into acceptable forms of practice. I argue that ethics in DCD go far beyond normative bioethical principles, to encompass concerns around: the reputation of hospital Trusts, public perceptions of organ donation, the welfare of potential donor families, and challenges to the work of health professionals caring for dying patients. The paper enriches understanding of ethics in science and medicine by showing how ethics are assembled and negotiated as a practical-organisational concern, and calls for further examination of how DCD gets constructed as a potential problem and is made to happen in practice.

Consent in body donation

“…These stewards would then try to make optimal decisions taking all relevant factors into consideration, including protecting the best interests of the deceased in light of all the information at their disposal. One advantage of consensus rather than individual proxy decisions is that the former may help avoid decisions being too heavily weighted by particular points of view, e.g., that of donors who registered their consent long in the past, relatives with strong but perhaps excessively self-serving views, or experienced anatomists whose training and practice have altered the ways that they think about bodies and what it is appropriate to do to them ;Segal, 1988;O'Neill, 1988;Joralemon, 1995;Delaney et al, 1996;Sanner, 1997;Moreton, 1999;Corrigan, 2003;Şehirli̇ et al, 2004;O'Neill, 2013;Boyd, 2015;Winkelmann, 2016;Hall & van Niekerk, 2017;Olejaz, 2017;Shaw, 2017;Champney et al, 2018;Cooper, 2018).…”

Atuação do enfermeiro como sensibilizador da família do potencial doador de órgãos e tecidos: revisão integrativa da literatura

“…O enfermeiro é um profissional que possui forte laço de confiança com os pacientes e seus familiares, devendo promover os interesses destes e assegurar que tenham acesso a todas as informações para a tomada de decisões e que seus direitos sejam respeitados. Essa tarefa, por vezes, pode esbarrar em dificuldades como impasses com outras categorias profissionais quando esses interesses divergem (Cooper, 2018).…”

“…Além disso, destaca-se a precisão de constituir sintonia com a família, para construir uma relação de confiança. Em Research, Society andDevelopment, v. 9, n. 10, e1559108127, 2020 (CC BY 4.0) | ISSN 2525-3409 | DOI: http://dx.doi.org/10.33448/rsd-v9i10.8127 seguida, se implica que o enfermeiro deve proporcionar uma escuta ativa, oferecendo conforto, com o intuito de os familiares aceitarem a morte com uma fase natural da vida (Cooper, 2018). Santos & Feito (2018) realizaram estudo com 18 enfermeiros que trabalhavam em uma Organização de Procura de Órgãos analisando o processo de entrevista familiar com foco na bioética dos princípios (artigo A5).…”

“…Existe certa controvérsia a respeito da doação de após determinação de morte circulatória, uma vez que ainda enquanto o paciente caminha para falência, são necessárias intervenções para garantir a qualidade dos órgãos para uma potencial doação. Esse conflito de papeis entre o esforço para otimizar o potencial doador e a medicina de final de vida levou ao desenvolvimento de novas diretrizes clínicas, éticas e legais que visam resolver essa ambiguidade e orientar para a melhor prática em saúde (Cooper, 2018). É apropriado preparar sempre a conduta.…”

Research on the Profession Ethics of Designers From Different Backgrounds

“…Reybold and Halx also has used drama as a medium to discuss ethics, focusing on student affairs. In addition, extensive ethical research has been carried out in medicine, [6][7]. Professional ethics-related courses have been implemented in universities around the world for decades, but some scholars reckon that professional ethics problems have not been well solved [8].…”