The organ donation conundrum

Ethics of Organ Donation and Transplantation: Toward Self-Sufficiency

Organ donation, intersecting medical necessity and ethical responsibility, calls for policies respecting individual autonomy while aiming for societal selfsufficiency. This article evaluates various government policies, emphasizing the ethical use of nudges in decision-making and the potential impact on autonomy. We argue that, while some policies might be coercive, others may inadvertently disrespect autonomy through subtle influences on decisionmaking. To reach self sufficiency in organ donation and transplantation and to keep adherent to medical ethics, especially informed consent, and gift of life campaigns, governments must determine the legal procedures by which their residents are registered, or can register, as organ donors. Provided that governments recognize that people have a right to determine what happens to their organs after they die, there are 4 feasible options to choose from: optin, opt-out, mandated active choice, and voluntary active choice. This article investigated the ethics of these policies' use of nudges and pokes to affect organ donor registration ways, rules, and rates. We argue that the use of nudges in this context is morally problematic. It is disrespectful of people's autonomy to take advantage of their cognitive biases since doing so involves bypassing, not engaging, their rational capacities. We conclude that, although mandated active choice policies are not problem free, they are coercive; after all, voluntary active choice, opt-in, and opt-out policies are potentially less respectful of people's autonomy since their use of nudges could significantly affect people's decision making.

Remapping the organ donation ethical climate: a care ethics consideration

Organ donation has gained much attention as the need for transplant exceeds the supply of organs. Various proposals have been put forward to address the organ shortage challenge, ranging from offering incentives to donors, addressing family refusals to donations and instituting presumed consent laws. Presumed consent as the favoured approach has not been universally effective in increasing actual transplants despite its appeal. Few considerations have been given to the broader ethical climate influencing the organ donation debate. This paper examines the ethical climate surrounding organ donation and identifies the challenges existing within such environments. It explores care ethics and its application to the donation system, demonstrating how it can influence the organ donation phases. The conclusion drawn from the analysis is that a caring ethical climate in the pre, during and post-transplant system respects donor autonomy, addresses family reluctance to agree to donation, facilitates the needs of the donee and creates an environment that promotes non-maleficence for all stakeholders.

Philosophy of organ donation: Review of ethical facets

Transplantation ethics is a philosophy that incorporates systematizing, defending and advocating concepts of right and wrong conduct related to organ donation. As the demand for organs increases, it is essential to ensure that new and innovative laws, policies and strategies of increasing organ supply are bioethical and are founded on the principles of altruism and utilitarianism. In the field of organ transplantation, role of altruism and medical ethics values are significant to the welfare of the society. This article reviews several fundamental ethical principles, prevailing organ donation consent laws, incentives and policies related to the field of transplantation. The Ethical and Policy Considerations in Organ Donation after Circulatory Determination of Death outline criteria for death and organ retrieval. Presumed consent laws prevalent mostly in European countries maintain that the default choice of an individual would be to donate organs unless opted otherwise. Explicit consent laws require organ donation to be proactively affirmed with state registries. The Declaration of Istanbul outlines principles against organ trafficking and transplant tourism. World Health Organization's Guiding Principles on Human Cell, Tissue and Organ Transplantation aim at ensuring transparency in organ procurement and allocation. The ethics of financial incentives and non-financial incentives such as incorporation of non-medical criteria in organ priority allocation have also been reviewed in detail.

Influence of Scientific Worldviews on Attitudes toward Organ Transplants: National Survey Data from the United States

Context

Public acceptance of routine medical procedures is nearly universal, but controversy over dramatic or invasive procedures like transplants is common.

Objectives

To assess the distributions and organization of public opinion on organ transplant and to discover the magnitude of the direct and indirect impacts of religion, scientific knowledge, and acceptance of evolution on individuals' support for organ transplant.

Participants

A representative sample (N = 2069) of the US adult, English-speaking population in 2009.

Intervention

Participants were administered the International Social Science Survey/USA 2009.

Results

Organ transplants were warmly endorsed by most Americans in 2009, as earlier, but support is not universal. Confirmatory factor analysis shows that Americans' opinions on heart, kidney, and pancreas transplants all reflect the same underlying attitude toward major organ transplants. Structural equation modeling shows that scientific knowledge is the most important influence on these attitudes, with more knowledgeable persons being more supportive. Acceptance of the theory of evolution is the second most important factor, also associated with greater support for transplant. Growing up in a church-going family encourages people to support organ transplant, even after adjusting for other influences. Otherwise denomination and religious belief have only small indirect influences. Demographic differences are small.

Conclusions

These results provide clues about future trends. A religious revival, were it to occur, would not be likely to alter support for transplants. If public knowledge of science continues to increase, or acceptance of the theory of evolution grows, support for transplant will most likely increase.

When the living and the deceased cannot agree on organ donation: a survey of US organ procurement organizations (OPOs)

The legal concept of first person authorization (FPA) is based on the principle that a decision by a person with decision-making capacity should be respected even after he or she dies. Although the transplant community largely supports this concept, its implementation has not been universal. We conducted a web-based survey of all 58 Organ Procurement Organization (OPO)executive directors in the United States to assess OPOs' procurement policies and practices in the context of family objections. All 58 respondents(100%) responded to our survey. All OPOs except one have an online donor registration website. Most OPOs(89%) (51 of 57 respondents) estimated that the frequency of family objecting to organ donation in cases of registered donors was <10%. No OPOs reported the frequency to be higher than 25%. Only 50% (27 of 54) of the OPOs have a written policy on handling family objections. Approximately 80% of the OPOs reported honoring FPA. However, in the past 5 years, 20 OPOs (35%) have not yet participated in organ procurement from a registered deceased donor over family objection. Further research to identify the barriers and possible solutions to implementing FPA is warranted.