30. ORGAN TRANSPLANTATION GUIDELINES

Question 1

1. What kind of transplant has become very well-established in the UK?

Answer 1

• Live Donor Transplantation
• 97% of these are live kidney donation transplants

Question 2

2. What is expected of all the Health Care Professionals involved with Living Donor Transplantations?

Answer 2

• they must be familiar with the general principles that
  are needed for good ethical practice

Question 3

3. What are the 6 Key Ethical Principles in Living Donor Kidney Transplantation?

Answer 3

1. Altruism
2. Autonomy
3. Beneficence
4. Dignity
5. Non-Maleficence
6. Reciprocity

Question 4

4. Define “Altruism”.

Answer 4

• it is a selfless gift towards others
• without the expectation of remuneration
• it is the basis of organ donation in the UK

Question 5

5. Define “Autonomy”.

Answer 5

• this is a form of valid consent
• it is required by the living donor before an organ can
  be removed

Question 6

6. Define “Beneficence”.

Answer 6

• these are the actions that serve the best interests of
  the patients

Question 7

7. Define “Dignity”.

Answer 7

• this is the inherent dignity or special status of the
  human body
• dignity and price are mutually incompatible

Question 8

8. Define “Non-maleficence”.

Answer 8

• this is the intent to do no harm through your actions

Question 9

9. Define “Reciprocity”.

Answer 9

• this is when we provide benefits or services to another
• it is part of a mutual exchange

EXAMPLE:
- paired and pooled organ donation

Question 10

10. According to Cronin, is it ethically acceptable for doctors to encourage altruistic organ donation?

Answer 10

• yes
• it is amazing to offer the gift of life
• donation brings about medical good for the society
• this is secondary to the individual medical good that
  the doctor seeks

Question 11

12. Why does Glannon believe it is unethical to encourage altruistic organ donation?

Answer 11

1. It can cause harm to the donor
2. Doctors have a secondary duty to promote organ
   donation
   - transplantation is a way to promote public health
   - the secondary duty should not precede the primary
   duty to your patient
3. Act in the best interest of the patient
   - respect their autonomy
4. The doctor may be seen as using coercion
   • this is due to the power imbalance with the patient
   • this poses valid consent consequences

Question 11

11. According to Glannon, is it ethically acceptable for doctors to encourage altruistic organ donation?

Answer 11

• no
• it is not ethical to urge your patient to risk their health
  for the benefit of others

Question 12

13. According to the General Medical Council, how should doctors approach Organ Donation ethically?

Answer 12

1. FOLLOW THE NATIONAL PROCEDURES
   - for identifying potential organ donors
   - and for notifying the local transplant co-ordinators
2. TAKE INTO ACCOUNT THE REQUIREMENTS FOUND IN
   RELEVANT LEGISLATION
   
   • as well as in any supporting codes of practice
     - and in any discussions had with patients and those
     close to them
3. MAKE IT CLEAR THAT ANY DECISION ABOUT
   WHETHER THE PATIENT IS A SUITABLE CANDIDATE
   FOR DONATION
   - is made by the transplant coordinator and their team
   - it is not made by you (the doctor)
   - it is not made by the team that provides the
   treatment

Question 13

14. Does this summary make sense?

Answer 13

• yes

Question 14

15. Answer these questions.

Answer 14

• this can be done verbally or on paper

Question 15

16. Answer this SBA.

Answer 15

• C.