Transplantation Flashcards
Why do we need donated bodies? We rely on donated bodies, or parts of bodies, for several important things: - - -
transplantation
scientific research
medical education
- The benefit of all these is significant, both to individuals and society more generally
- The more donations, the greater the benefit
Talk about consent
Important to make use of available resources but have to consider consent
Most of the UK operate an opt-in system
(Wales switched to opt-out)
and your next of kin will also be asked whether they agree with your decision, when you die). Next of kin used to be able to overrule decision but not now
- Donation will not go ahead without consent.
If donation can bring about so much good, why worry about consent? x3
- Respect for autonomy = people expect to have control over their bodily integrity while alive, so why not when they are dead/dying? Coercian is often considered unacceptable, especially within a medical context
- Respect for individuals values/beliefs = people may have religious objections to donation, or believe that they need to keep their body intact
- Concern for people who are still alive? = it may distress relatives to know that organs or whole bodies are being ‘donated’ or used without consent
What was the Alder Hay scandal?
- Parents had given consent for post mortals to be carried out - they had either specifically requested that all organs be kept together for burial, or they had simply not been informed the hospital might retain organs
- public outcry, immesensly distressing for parents, damaged reputation of NHS/donation etc
- in the wake of the scandal, the DoH issued new guidelines, so relatives must be fully informed –> Human Tissue Act 2004
What are the 3 parts of the HCA 2004 and Transplantatoin?
Part 1 = Consent and organ transplantation
Part 2 = Human Tissue Authority
Part 3 = misc.
What is appropriate consent in live organ donation when it comes to children?
Children who are competent can give consent
Competent = Gillick competent
If the child is not competent - then someone with parental responsibility an give honest but has to be in their best interests - not simple! –> saviour siblings
What is appropriate consent in dead organ donation when it comes to children?
- children who are competent can give consent: advanced declaration, for their organs to be used for transplantation
- if the child is not competent, then someone with parental responsibility can give consent
What is appropriate consent for adults in dead and alive organ donation?
Live - adults must give consent
Dead - adults can give prior consent: advanced declaration, for their organs to be used for transplantation
OR
failing an advance declaration consent can be obtained from a ‘nominated person’ to make decision after their death
OR
if the deceased didn’t nominate a named representative:: next of kin
What 3 things are the human tissue authority responsible for?
- remit - licensing
- issue codes of practice
- regulates the transplants between living persons and prohibits commercial dealing in human material
Hospital authorities take minimum steps to preserve organs of deceased persons whilst the appropriate consent to transplantation is sought. Is this lawful?
yes - section 43 of HTA
Give of summary of changes to the HTA
- consent is the cornerstone
- where a competent individual is giving consent or has given consent - this should be overriding factor
- hitherto, practice has always been to ask the next of kin, regardless of any advance declaration made by the donor
Role of public opinion in transplantation:
Should we worry about what people think of:
1.
2.
3.
- organ donation
- organ allocation
- how bodies and their parts are used more generally after death
- These are all moral issues
Since organs are a scarce resource, it is important that they are put to good use. But what is good use?
- preventing death?
- providing good quantity of life?
- providing good quality of life?
- providing equal access to treatment?
- prioritising certain types of person (children, for instance)
- research?
Whose view should count regarding these issues?
- We live in a relatively free, democratic society, that tries to respect autonomy, values and beliefs
- But people are prone to be wrong
- so whose views should count?
- doctors/scientists?
- politicians?
- bioethicists?
- the public?
Why are the following people important?
- Doctors/scientists
- Bioethicists
- Public
- doctors and scientists know about tissue typing and likely risks/benefits
- bioethicists know about key ethical principles and what they require e.g. justice
- the public may be less leaky ot donate if they find the system to the objectionable
