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Cignarella A, Marshall A, Ranse K, Opdam H, Buckley T, Hewitt J. Identity Disclosure Between Donor Family Members and Organ Transplant Recipients: A Description and Synthesis of Australian Laws and Guidelines. JOURNAL OF BIOETHICAL INQUIRY 2024; 21:309-329. [PMID: 38060147 DOI: 10.1007/s11673-023-10287-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 07/20/2023] [Indexed: 12/08/2023]
Abstract
INTRODUCTION The disclosure of information that identifies deceased organ donors and/or organ transplant recipients by organ donation agencies and transplant centres is regulated in Australia by state and territory legislation, yet a significant number of donor family members and transplant recipients independently establish contact with each other. AIM To describe and synthesize Australian laws and guidelines on the disclosure of identifying information. METHOD Legislation and guidelines relevant to organ donation and transplantation were obtained following a search of government and DonateLife network websites. Information about the regulation of identity disclosure was extracted and synthesised using a process guided by Walt and Gilson's (1994) policy analysis framework. FINDINGS Nineteen documents were examined. Six guidelines refer to and were consistent with current legislation. Four documents did not address identity disclosure. All jurisdictions prohibit healthcare professionals from disclosing identifying information. In three states, the prohibition extends to all members of the public including donor family members and transplant recipients. CONCLUSION Restrictions on identity disclosure have implications for public promotion of donation and transplantation where sharing of stories and images of organ donors and transplant recipients is common. Further research is required to understand the perspective of donor family members, transplant recipients, and healthcare professionals impacted by the current laws.
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Affiliation(s)
- Anthony Cignarella
- School of Nursing and Midwifery, Griffith University, 1 Parklands Drive Southport, Gold Coast, QLD, 4222, Australia.
- Peninsula Health, Frankston Hospital, Learning Hub, 2 Hastings Road Frankston, Melbourne, VIC, 3084, Australia.
| | - Andrea Marshall
- School of Nursing and Midwifery, Griffith University, 1 Parklands Drive Southport, Gold Coast, QLD, 4222, Australia
| | - Kristen Ranse
- School of Nursing and Midwifery, Griffith University, 1 Parklands Drive Southport, Gold Coast, QLD, 4222, Australia
| | - Helen Opdam
- Intensive Care Unit, Austin Health, The Austin Hospital, 145 Studley Road Heidelberg, Melbourne, VIC, 3084, Australia
- Australian Organ and Tissue Authority, 14 Childers Street Level 3, Canberra City, ACT, 2601, Australia
| | - Thomas Buckley
- School of Nursing and Midwifery, The University of Sydney, Susan Wakil Health Building Level 8, D-18 Western Avenue Camperdown, Sydney, NSW, 2006, Australia
| | - Jayne Hewitt
- School of Nursing and Midwifery, Griffith University, 1 Parklands Drive Southport, Gold Coast, QLD, 4222, Australia
- Law Futures Centre, Griffith University Law School, 170 Kessels Road, Nathan, QLD, 4111, Australia
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Toews M, Chandler JA, Pope T, Pape R, Weiss M, Sandiumenge A. Legislation and Policy Recommendations on Organ and Tissue Donation and Transplantation From an International Consensus Forum. Transplant Direct 2023; 9:e1395. [PMID: 37138556 PMCID: PMC10150854 DOI: 10.1097/txd.0000000000001395] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 08/12/2022] [Accepted: 08/25/2022] [Indexed: 05/05/2023] Open
Abstract
There is a shared global commitment to improving baseline donation and transplantation performance metrics in a manner consistent with ethics and local cultural and social factors. The law is one tool that can help improve these metrics. Although legal systems vary across jurisdictions, our objective was to create expert, consensus guidance for law and policymakers on foundational issues underlying organ and tissue donation and transplantation (OTDT) systems around the world. Methods Using the nominal group technique, a group composed of legal academics, a transplant coordinator/clinician, and a patient partner identified topic areas and recommendations on foundational legal issues. The recommendations were informed by narrative literature reviews conducted by group members based on their areas of expertise, which yielded a range of academic articles, policy documents, and sources of law. Best practices were identified from relevant sources in each subtopic, which formed the basis of the recommendations contained herein. Results We reached consensus on 12 recommendations grouped into 5 subtopics: (i) legal definitions and legislative scope, (ii) consent requirements for donation' (iii) allocation of organs and tissue' (iv) operation of OTDT systems' and (v) travel for transplant and organ trafficking. We have differentiated between those foundational legal principles for which there is a firm basis of support with those requiring further consideration and resolution. Seven such areas of controversy are identified and discussed alongside relevant recommendations. Conclusions Our recommendations encompass some principles staunchly enshrined in the OTDT landscape (eg, the dead donor rule), whereas others reflect more recent developments in practice (eg, mandatory referral). Although some principles are widely accepted, there is not always consensus as to how they ought to be implemented. As the OTDT landscape continues to evolve, recommendations must be reconsidered for the law to keep pace with developments in knowledge, technology, and practice.
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Affiliation(s)
- Maeghan Toews
- University of Adelaide, Law School, Adelaide, SA, Australia
| | - Jennifer A. Chandler
- Faculty of Law and Centre for Health Law, Policy and Ethics, University of Ottawa, Ottawa, ON, Canada
| | - Thaddeus Pope
- Mitchell Hamline School of Law, Saint Paul, MN
- Fulbright Canada Research Chair in Health Law, Policy and Ethics, University of Ottawa, Ottawa, ON, Canada
| | - Roger Pape
- National Institutes for Health Research/NHS Blood and Transplant Research Unit, University of Cambridge and Newcastle University, Cambridge and Newcastle, UK
| | - Matthew Weiss
- Transplant Québec, Montréal, QC, Canada
- Division of Critical Care, Department of Pediatrics, Centre Mère-Enfant Soleil du CHU de Québec, Québec, QC, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Alberto Sandiumenge
- Transplant Coordination Department, University Hospital Vall d'Hebron, Organ, Tissue and Cell Donation and Transplantation Research Group, Vall d'Hebron Research Instititute (VHIR), Barcelona, Spain
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Murphy NB, Allingham D, LeBlanc K, Slessarev M, Ward M, Weijer C. A Pressing Need for Effective, Clear, and Consistent Regulations to Facilitate Direct Contact Between Donor Families and Organ-Transplant Recipients. Can J Cardiol 2022; 38:703-704. [DOI: 10.1016/j.cjca.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/07/2022] [Accepted: 01/08/2022] [Indexed: 11/28/2022] Open
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Cignarella A, Ranse K, Hewitt J, Opdam H, Romero L, Marshall A. Identity disclosure between donor families and organ transplant recipients: an integrative review of the international literature. PSYCHOL HEALTH MED 2022:1-23. [PMID: 35272546 DOI: 10.1080/13548506.2022.2050272] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Anonymity of deceased organ donation is a legal requirement in many international jurisdictions where legislation prohibits health professionals from disclosing identifiable information about donors, recipients or their families. Written correspondence between donor families and transplant recipients that is coordinated by healthcare professionals must remain anonymous. Internationally, an increasing number of donor families and transplant recipients have advocated for law reform and policy amendment to enable the exchange of identifiable written correspondence and/or face-to-face meetings. This paper aims to synthesise and critically evaluate published, peer-reviewed literature on the perceptions, benefits and challenges of identifiable communication or anonymity between donor families and organ transplant recipients in the international context. Analysis of the findings revealed two major themes: (1) views held by donor families, transplant recipients and healthcare professionals towards identity disclosure in the context of organ donation are diverse across and within groups (2) there are benefits and burdens associated with connecting donor families and transplant recipients through written correspondence. Less is known about the impact of face-to-face meetings between donor families and transplant recipients. However, what is known is that for some donor families, meeting with the transplant recipient(s) may provide a range of positive emotions.
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Affiliation(s)
- Anthony Cignarella
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia.,The Alfred Hospital, Alfred Health, Nursing Education, Melbourne, Victoria, Australia.,The Alfred Hospital, Alfred Health, Intensive Care Unit, Melbourne, Victoria, Australia
| | - Kristen Ranse
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia.,Intensive Care Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Jayne Hewitt
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia.,Griffith Law School, Griffith University, Gold Coast, Queensland, Australia
| | - Helen Opdam
- Australian Organ and Tissue Authority, Canberra, NSW, Australia.,The Austin Hospital, Austin Health, Intensive Care Unit, Melbourne, Victoria, Australia
| | - Lorena Romero
- The Alfred Hospital, Alfred Health, Melbourne, Victoria, Australia
| | - Andrea Marshall
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia.,Nursing and Midwifery Education and Research Unit, Gold Coast University Hospital, Gold Coast, Queensland, Australia
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Legislative proposal in Italy to facilitate contacts between deceased organ donor families and transplant recipients. J Nephrol 2020; 33:1333-1342. [PMID: 32776279 DOI: 10.1007/s40620-020-00824-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 08/01/2020] [Indexed: 10/23/2022]
Abstract
Contacts between organ donors and recipients might be possible in the near future in Italy. As suggested by The Italian Committee of Bioethics "anonymity is requested by the Italian National Transplant Centre" before transplantation anonymity shall be strict in order to grant privacy, gratuity, justice, solidarity and benefits and avoids organ trafficking. Following a period that is ethically correct and justifiable, organ donor families and recipients can meet after signing a valid declaration of consent, expressed on a template valid for the whole country. A third party within the body of the National Health Systems shall control the validity of the consent. The opinion stresses that contacts are not a right but a possibility justifiable on ethical grounds if the procedure is followed appropriately. A legislative proposal has been presented before the Chamber of deputies incorporating all suggestions made by the National Committee of Bioethics. The agreement between parties might be signed a year after transplantation. This is a long enough period of time for the recipients to fully appreciate the benefits of the procedure and for the donor families to see the effects of their decision (the opinion and the Law proposal hit the Zeitgeist, and keep Italy in the regulation of European Union).
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Dicks SG, Northam H, van Haren FMP, Boer DP. An exploration of the relationship between families of deceased organ donors and transplant recipients: A systematic review and qualitative synthesis. Health Psychol Open 2018; 5:2055102918782172. [PMID: 30083368 PMCID: PMC6069040 DOI: 10.1177/2055102918782172] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Following deceased organ donation and transplantation, the narratives of families of donors and organ recipients become connected. This is acknowledged when parties receive anonymous information from donation agencies and transplant centres, when they exchange correspondence or when they meet in person. This article reviews literature describing the experience from the points of view of donor families, recipients, and other stakeholders to explore the dynamic system that evolves around this relationship. Findings highlight a link between identity development and ongoing adjustment and will assist those supporting donor families and recipients to make decisions that fit meaningfully.
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Affiliation(s)
| | | | - Frank MP van Haren
- University of Canberra, Australia
- Australian National University,
Australia
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