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Ethics: Organ Donation


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Hi, I wanted some input as how you would approach this scenerio.

 

Scenerio:

 

Mrs. Jones has signed a donor card indicating that she is willing to donate her body to science without notifying her husband and son. She gets into an accident and it is determined that she is brain dead. The family doctor, who is on call that afternoon, reviews the chart and determines that she would be perfect for medical students to practice the removal of organs for transplantation purposes. The doctor then talks to the family to discuss the procedure and to confirm their consent. They both oppose the procedure and refuse to allow their doctor to move forward. The doctor points out that Mrs. Jones could be helping hundreds of people by educating the medical students and that technically consent has already been provided. The husband understands how beneficial the educational experience is but is too emotional to allow them to continue. The son, a medical student, refuses because he knows the bodies are not treated with dignity. If you were the doctor, how would you proceed? Why?

 

 

I think:

1) the family refuses consent but Mrs. Jones already gave her consent --> so legally, we can use her organs

2) I would first discuss with colleagues or hospital administration regarding the protocol in these situations if uncertain

3) Since Mrs. Jone's family is in a state of distress, its important to address and acknowledge how they are feeling and maybe provide them with grief counselling

 

 

 

I think it would also be appropriate to wait as long as possible for the organ donation procedure until the family feels their concerns have been heard.. because you don't want them to mistrust the healthcare system/you as the physician

 

Any other ideas?

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You have created a ticklish situation indeed and I am not sure of the legalities involved. On the basis that her signed consent is legally binding, then the doctor ought not to meet with family "to obtain their consent", rather to inform them, in case they are unaware, that they may remain with the body for awhile to say their goodbyes, pointing out that the deceased signed an informed consent to donate her body to science and that, in the circumstances, the body will not be released to the family. End of story. The family will then be free to try to take any recourse they may wish. However, the last wishes of te person must be respected.

 

I am aware of a case some years ago where the deceased, a diabetic, left her eyes to the eys bank. The dr. ionformed the family that eyes could not be used but he was still removing the eyes b/c he received credit from the eye bank for his patients. He did not ask, he told!

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I think that I agree with 2010hope. The family is in a state of distress and I think they MUST be included in the discussion as to whether her organs will be donated to science. Yes, the woman that is brain dead has written documentation saying she wants to do this, but her family must be stressed out because a) a loved one has essentially died B) they are faced with a difficult situation in that people want to remove her organs. I mean, if you were in this situation, wouldn't you be completely distressed?

 

I think that the doctor that is involved in this case would have to understand that the resistance to the family could be for all sorts of reasons a) religious B) that by letting the doctor remove the organs, they will be the cause of her bodily death (although she is brain dead) and this might feel like a betrayal to the loved ones letting this happen....they need time to accept she is essentially dead and that she made this decision that could benefit a lot of people. I think that in order to move forward, you really need to be compassionate for the family and patient, even though time might not be on your side.

 

I think rushing in and telling the family that this procedure will take place without discussing with it them first had would be a grave mistake and would make them feel abandoned.

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I am aware of a case some years ago where the deceased, a diabetic, left her eyes to the eys bank. The dr. ionformed the family that eyes could not be used but he was still removing the eyes b/c he received credit from the eye bank for his patients. He did not ask, he told!

 

Harsh! Maybe this is how it happens in medicine, but this seems a cruel way to treat a family that has already gone through so much.

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I was under the illusion that even if you sign a donor card, you should make your intentions aware to your family (spouse or children) because the ultimate decision is theirs.

 

Dunno where I heard/read this, though it would make sense that it's wrong.

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I guess that makes sense. When you are brain dead, clearly you cannot make decisions for yourself, so the decision makers would become the family members? But you did sign the documentation...so I don't know who has the final say.

 

and in response to HBP

 

http://www.forms.ssb.gov.on.ca/mbs/ssb/forms/ssbforms.nsf/AttachDocsPublish/014-3750-84~1/$File/3750-84E.pdf

 

at the bottom right hand corner it says that you need to inform your family of your decision to give up your organs (and which ones) for organ transplant. Not quite the same thing as donating one's body to medicine....but close.

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I agree with futuredoc, that the deceased's wishes should be respected. Provided the document is legit, it's what the person wanted. That being said, the family should be treated compassionately and allowed some time to process what's going on and ask questions etc.

 

It probably wouldn't be the right time, but I'd also want to know more about the son's statement that med students don't treat their cadavers with respect. That's not cool, and maybe someone should look into it.

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So are you guys saying it's different in the case of donation for science and donation for organ transplant?

 

Well, maybe....god forbid a relative of mine becomes brain dead and makes the same requests. But if that were the case, I think that I would be more comfortable with their decision to give up their organs for transplant because with that gift it would do good and may alleviate the suffering of another person, whereas if they donated their body to medicine I might be less comfortable.

 

I've never seen people dissect a body, but I remember how people treated the real skeleton in our high school/ how students treated the dead rats they were dissecting, and it was quite disrespectful (a student even played catch with a dead rat while laughing that it looked silly because its tongue was sticking out).

 

Edit: right now I am going upstairs to let my family know that if something terrible happened to me, that I would be donating my organs for organ transplantion!

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Well, maybe....god forbid a relative of mine becomes brain dead and makes the same requests. But if that were the case, I think that I would be more comfortable with their decision to give up their organs for transplant because with that gift it would do good and may alleviate the suffering of another person, whereas if they donated their body to medicine I might be less comfortable.

 

I've never seen people dissect a body, but I remember how people treated the real skeleton in our high school/ how students treated the dead rats they were dissecting, and it was quite disrespectful (a student even played catch with a dead rat while laughing that it looked silly because its tongue was sticking out).

 

Edit: right now I am going upstairs to let my family know that if something terrible happened to me, that I would be donating my organs for organ transplantion!

 

Ever seen Weekend at Bernie's? Now that's the way to treat a corpse.

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According to this Quebec government site:

 

http://www.ramq.gouv.qc.ca/en/citoyens/assurancemaladie/autressituations/don_organes.shtml

 

"When you consent to an organ donation, it is important to inform your next of kin, since they are the ones who will authorize the medical team to remove your organs."

 

So then, although Mrs. Jones gave consent but her family now refuses consent, does this then this must mean that the familie's wishes would now have to be followed unless the doctor can convince them otherwise?

 

 

EDIT: http://www.cmaj.ca/cgi/reprint/157/2/160.pdf

 

" Almost without exception, however, organ-retrieval protocols of Canadian transplant societies state that consent of the donor’s next of kin is required for organ retrieval

even when the donor has given explicit consent and there is a donor card or sticker. They further state that if the next of kin refuse to provide consent, the organs

should not be retrieved.

For example, guidelines on organ and tissue donation prepared by the Multiple Organ Retrieval and Exchange Program of Ontario state: “A signed driver’s licence/donor

card is considered a legal document but it is the practice of the transplant programs to follow the wishes of the next of kin. If the next of kin refuse consent for organ and/or tissue

donation their wishes must be respected.”

 

So I guess when the doctor in this scenerio should respect the families wishes. Anyone oppose this?

 

 

I guess that makes sense. When you are brain dead, clearly you cannot make decisions for yourself, so the decision makers would become the family members? But you did sign the documentation...so I don't know who has the final say.

 

and in response to HBP

 

http://www.forms.ssb.gov.on.ca/mbs/ssb/forms/ssbforms.nsf/AttachDocsPublish/014-3750-84~1/$File/3750-84E.pdf

 

at the bottom right hand corner it says that you need to inform your family of your decision to give up your organs (and which ones) for organ transplant. Not quite the same thing as donating one's body to medicine....but close.

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...

" Almost without exception, however, organ-retrieval protocols of Canadian transplant societies state that consent of the donor’s next of kin is required for organ retrieval

even when the donor has given explicit consent and there is a donor card or sticker. They further state that if the next of kin refuse to provide consent, the organs

should not be retrieved.

...

If the next of kin refuse consent for organ and/or tissue

donation their wishes must be respected.”

...

 

So is the opposite also true?

 

If someone has not expressed prior wishes to be an organ donor, can the next of kin authorize this decision on behalf of the deceased patient?

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In the absence of known wishes of the deceased that organs are not to be donated, I would think under your scenario that the family could make this decision that would be complied with. Just think about people for whom l ife support is withdrawn and the family donate the heart, kidney of the deceased and/or other organs.

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So is the opposite also true?

 

If someone has not expressed prior wishes to be an organ donor, can the next of kin authorize this decision on behalf of the deceased patient?

 

yes

 

I think the problem (if I remember my law classes right) is that upon death all contracts (except wills, and even these can be challenged) are void, and you are simply property and without basic rights. Specifically you are property of the next of kin, who can do whatever they want within defined legal bounds - including override the request.

 

So your organ donation request (a contract of sorts) simply holds no water at all once you are dead.

 

Not to mention the up roar that would occur if a doctor overrode the family!

 

I wonder though, how often does this actually occur?

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yes

 

I think the problem (if I remember my law classes right) is that upon death all contracts (except wills, and even these can be challenged) are void, and you are simply property and without basic rights. Specifically you are property of the next of kin, who can do whatever they want within defined legal bounds - including override the request.

 

So your organ donation request (a contract of sorts) simply holds no water at all once you are dead.

 

Not to mention the up roar that would occur if a doctor overrode the family!

 

I wonder though, how often does this actually occur?

 

We are able to enterinto contracts over property that maintain effect after o ur death and yet, we cannot enter into validly binding contracts concerning our own organ donation after our own deaths. If we become property then we should be able to make legally binding undertakings that cannot be overridden by our next-of-kin, some of whom may have unhealthy agendas, for example, pulling the plug when the deceased could not participate in te decison could result in the decision maker obtaining an inheritance sooner than otherwise and saving perhaps the cost of additional care.

 

There is a gap in the law that should be addressed. I would like to have control over what is done with my remains upon my death and not leave it to the whim of family. I guess I would need to have a clause in my Will making bequests conditional upon my remains being dealt with in accordance with my wishes as expressed in my organ donation card - and should my remains not ber so dealt with, such bequests are to be considered nul and void, with the monies going to specifically named charities instead. I would alert the charities - so that they would see that justice is done, i.e., there would be a legal dispute and the charities would have an incentive and fiduciary duty to protect their gift from any claim of family for these monies. I know, this is rather a convoluted way to ensure my remains are dealt with in accordance with my written instructions/consent. That is precisely why the law needs to be changed!

 

As to how often, adoctor would override a family, I would think not all that often, but it does occur.

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We are able to enterinto contracts over property that maintain effect after o ur death and yet, we cannot enter into validly binding contracts concerning our own organ donation after our own deaths.

 

It would be interesting if some put in a will that their property (which must include your own body, I mean who else could own it :) ), to the donor service. That would be an interesting legal challenge!

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It would be interesting if some put in a will that their property (which must include your own body, I mean who else could own it :) ), to the donor service. That would be an interesting legal challenge!

 

Indeed! :P Do it both was, the organ donation card and in the Wiil! And for good measure, the bequeath to charity if body does not go as directed under Will. :) Perhap, that is why the exprersssion was created, "Where there is a will, there is a way".;)

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Indeed! :P Do it both was, the organ donation card and in the Wiil! And for good measure, the bequeath to charity if body does not go as directed under Will. :) Perhap, that is why the exprersssion was created, "Where there is a will, there is a way".;)

 

hahahahahaha!

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