Organ Donation

Question 1

Why is deceased organ donation important?

Answer 1

• An average of 3 people die everyday waiting for an organ transplant
• living donation provides some organs but not enough:
  
  • provides mostly kidneys and some liver lobules
  • small but real risk to healthy donors
  • deceased donation is the only option for some transplants
• Therefore it is desirable to increase the rates of deceased donation.

Question 2

What is the main principle for organ donation - the starting point?

what ethical priniciples agree with this principle?

Answer 2

A good organ donation system should maximise the number of organs avaiable for transplantation -

this means that the most lives can be improved or extended

• good from a consequentialist / utilitarian perspective

Question 3

What could we implement to maximise the number of deceased organ donors?

Answer 3

If we only want a system to maximise the number of organs available for donation we could make organ donation compulsory

Question 4

What is the fate of organs if they are not donated?

Answer 4

We know for certain that if organs are not donated they will either be buried or burned.

This is a waste of a valuable resource - however people are currently allowed to do this due to other moral considerations.

Question 5

What is the fundamental consideration/ principle of deceased organ donation?

Which act is key to this?

Answer 5

The fundamental consideration of deceased organ donation is CONSENT.

The HTAact makes consent the fundamental principle for the lawful storage and use of human tissue.

Question 6

How can consent requirements vary?

Answer 6

Consent requirements vary depending upon what is donated and whether the donor is living or dead.

Appropriate consent refers to who can give consent

Question 7

What should the ideal organ donation system balance?

Answer 7

Good organ donation system needs to balance:

maximising the number of organs available for transplantation

in a way that results in people’s wishes being respected

Question 8

What are the benefits of an opt in organ donation system?

Answer 8

• Opt in allows us to respect individual’s autonomy
  
  • ​people should be free to make decisions about their own medical treatment
  • people should be free to make decisions about what happens to their body when they die
  • opt in means you can be fairly certain someone has opted in - and that we are following their wishes uf we retrieve their organs
  • joining the organ donation register counts as appropriate consent
• organ donation is characterised as a selfless and altruistic gift
• gifts can have the greatest meaning when they are given voluntarily and freely

Question 9

What are some of the problems with the opt in system?

Answer 9

• may people are in favour of organ donation but never get round to the organ donation register
• therefore the biggest problems with opt in donation systems are:
  
  • they dont provide enough organs - flawed from a consequentialist perspective
  • they dont result in everyone’s wishes about donation being followed ( flawed from an autonomy respecting perspective)

Question 10

what three factors should the ideal organ donation system include?

Answer 10

1. it should maximise the number of organs available for transplantation
2. but should do so in a way that results in people’s wishes being respected
3. and should make it easy for people to record their wishes (so they can be respected).

Question 11

What are the benefits of an opt out system?

Answer 11

• Individuals are still free to choose whther to become an organ donor - we still respect autonomy.
• By making donation the default - people do not have to take action to become an organ donate
  
  • this hopefully results in more donors
  • good from consequentialist perspective

Question 12

What are some of the potential problems with opt out?

Answer 12

• would the state take ownership of donated organs? - no
• people being unaware of the move to an opt out system - maybe an issue
• people being opposed to donatig but not getting around to opting out - maybe an issue
• people changing their mind after having recorded their wishes - maybe an issue

Question 13

who’s needs and competing interests are involved in organ donation?

Answer 13

decisions and actions regarding organ donation can affect multiple people:

1) dying or dead patient - potential organ donor
2) potential organ recipient
3) relatives
4) medical staff
5) wider community

Question 14

What three things help when trying to negotiate the wed of entangled interests surrounding organ donation?

Answer 14

• respecting the absolutes
• balancing competing interests where appropriate
• identifying and acting to further mutual interests
• in doing this you can establish which ethical issues are necessary barriers to organ donation and which are barriers that can be removed

Question 15

What is the dead donor rule?

Answer 15

An ethical norm in deceased donation which can take 2 related forms:

1) organ donors must be dead before retrieval of organs
2) organ donation must not cause the death of the donor

Question 16

Why is diagnosis of death an issue in organ donation?

Answer 16

1) there is currently no statutory definition of death in the UK
2) need to have “living organs” in good condition in order to be suitable for transplantation
3) but we also need the donor to be dead

Question 17

What is the definition of the dying process?

Answer 17

Dying involves irreversible changes to the brain resulting in irresversible loss of conciousness and irreversible loss of the capacity to breathe.

Question 18

What are two types of death allowed for organ donation?

Answer 18

1. Brainstem death - death following the irreversible cessation of brainstem function
   
   • ​​donation after brain stem injury = DBD
2. Circulatory death - death following the irreversible cessation of cardiorespiratory or circulatory function.
   
   • ​​donation after circulatory death = DCD

Question 19

what does diagnosis of death have implications for the organ donation process?

Answer 19

• diagnosis of death has implications for the organ donation process:
  
  • which organs can be donated - DCD heart donation is controversial
  • the “quality” of the organs when they are retrieved
  • permissible actions to “optimise’ organs
  • how relevant legislation should be applied

Question 20

Treatment to facilitate donation - why is this necessary and what might be involved?

Answer 20

• In order for a patient to become a donor certain interventions may actually be necessary
• doing certain things to the potential donor may provide benefit to the eventual organ recipient:
  
  • blood tests and analysis
  • temporary continued ventilation
  • other more invasive procedures e.g femoral cannulation
  • time and place of withdrawal of treatment
• this is particularly significant for DCD donation - as the patient is still alive- but also applies to DBD

Question 21

What are the ethical issues surrounding interventions on the donor?

Answer 21

• potential donor is unlikely to be able to give consent themselves - but in the case of DCD they are still alive
• this falls under the mental capacity act
• best interests go beyong treating a person’s medical condition
  
  • social, emotional, cultural and religious interests should also be considered
• if a person wishes to be an organ donor then treatment to facilitate or optimise this may be considered to benefit them

Question 22

How far can best interests to enable donation go?

Answer 22

• delaying withdrawal of treatment
  
  • sometiems it may be necessary to maintain treatment until everything is in place for organ donation to take place
• changing the way a person dies
  
  • there are some benefits if a person donates after brain death rather than circulatory death
• retrieve organs before the patient is dead? - some poeple have argued in favour of this but this goes against the dead donor rule