transplant ethics Flashcards
4 classifications of living donation
Directed v non-directed donation
Paired & Pooled donation
Domino donation
‘Altruistic’ v ‘Self interested’
6 solutions for donor organ finding
Opt-in system (hard or soft)
Opt-out system (hard or soft)
Mandated choice
Mandatory donation
Benefits-in-kind
Markets
type of system in UK and Wales
opt out
problem with opt in
Doctors were hesitant to go against family’s wishes if they disagreed with the deceased relative’s choice to donate.
type of system in Texas
mandatory: decision on application for drivers license
did Texas show and increase in organ donors after implementing mandatory donation?
no, decrease in donation
Israeli system
reimburse people for earnings lost and medical expenses
Iranian system
legal market
discuss the ethics behind legal markets
Exploitative; decline in altruistic donors; Commodification of bodies; we should never be a means to another’s end; may save many lives and maximise utility;
System is partially regulated system and designed to minimise exploitation; Illegal trade very much in operation anyway; commodification - sale of hair, semen, eggs, even surrogacy now permitted in many countries; Altruism is noble, but the extra lives saved are worth more; Donors will decide if they are better off with the money – and won’t donate if not; Increased autonomy with an increased set of options
describe some other specific issues to consider alongside transplant
Neonatal (including anencephalic) transplants
Paediatric donation
Non capacitous adult transplantation
High risk donors / recipients (e.g. elderly; HIV)
Face and Head/Body Transplants
Doctors diagnosing death ‘too quickly’ (?)
Artificial ventilation
Doctors actively encouraging patients to donate
Equality issues (e.g. ethnic minorities)
4 legislations/regulations related to organ donation
NHS Blood and Transplant (NHSBT)
responsible for efficient supply of blood, organs and associated services to the NHS
Human Tissue Act (2004)
provides the legal framework for organ donation
Organ Donation (Deemed Consent) Act 2019 Amends of HTA (2004), in force from Spring 2020
The Human Tissue Authority
aims to ensure that human tissue is used safely, ethically, and with proper consent.
describe the role of HTA panel in living donation
HTA to approve all (related or not) including paired/pooled and altruistic (directed or not)
HTA Independent Assessor (IA) to meet donors/recipients and to report to HTA
HTA Panel must consider special cases (e.g. children)
4 groups excluded from the opt out system in the UK
Thoseunder the age of 18
People who lack the mental capacity to understand the new arrangements and take the necessary action
Visitors to England, and those not living here voluntarily
People who have lived in England for less than 12 monthsbefore their death
4 pros of deemed consent
Beneficence – could save lives
Autonomy - consistent with a view of a majority so presumably better for autonomy
Autonomy – neutral for autonomy as replaces asking relatives for consent
Alleviates some burden on family members
5 cons of deemed consent
Autonomy: Potential violation of donors autonomy/nonsensical
Is the organ no longer a gift or donation(?)
Psychological harm to family members (?)
Misses the point
Public trust/consequences
