Ethics: Organ Donation

[HBP]

Do you have any articles/webiste information that has more information about this?

 

i thought this thread established that it's entirely up to next of kin...

[2010hope]

Well based on the forum discussion, its clear that if the deceased consents to organ donation its still up to the kin to authorize removal of the organs.

 

What I wasn't sure of was if the deceased did not consent to organ donation (eg. didnt sign the card), can the family still consent to organ donation even though the deceased may not have wanted it?

 

People replied yes to this question on the thread, but I was just wondering if this information was explicitly stated anywhere. I just wanted to make sure I understood this correctly.

 

 

i thought this thread established that it's entirely up to next of kin...

[Monaco]

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.

 

I was also under the impression that signing your donor card/consent form is not legally binding. The family can still refuse and usually the final consent is obtained from them (after considering the patient's wishes while they were alive and competent, blah, blah).

 

I also would not consider a signed donor card in the same category as signed informed consent that is supposed to document that a discussion about the procedure, benefits and material risks took place. Even with the latter document, it is not legally-binding and consent can be withdrawn at any time. A family could make the argument that a signed donor card does not represent informed consent since the patient didn't know what the organ donation process really entails.

[Monaco]

Well based on the forum discussion, its clear that if the deceased consents to organ donation its still up to the kin to authorize removal of the organs.

 

What I wasn't sure of was if the deceased did not consent to organ donation (eg. didnt sign the card), can the family still consent to organ donation even though the deceased may not have wanted it?

 

People replied yes to this question on the thread, but I was just wondering if this information was explicitly stated anywhere. I just wanted to make sure I understood this correctly.

 

If the patient explicitly told his/her doctor that s/he was adamantly against organ donation, I think the medical team would have an obligation to bring this up with the family. However, in this case, if the family were for some reason obsessed with donating the organs, they could say that the patient changed her mind, expressed her wishes while she was competent, donating would be compatible with her general values and philosophies, etc.

 

Usually the medical team doesn't know what the patient would have wanted, and sometimes they don't even know the patient as a person at all, so decisions end up being deferred to the family.

[estairella]

If the patient explicitly told his/her doctor that s/he was adamantly against organ donation, I think the medical team would have an obligation to bring this up with the family. However, in this case, if the family were for some reason obsessed with donating the organs, they could say that the patient changed her mind, expressed her wishes while she was competent, donating would be compatible with her general values and philosophies, etc.

 

Usually the medical team doesn't know what the patient would have wanted, and sometimes they don't even know the patient as a person at all, so decisions end up being deferred to the family.

 

Bingo. If your family wants you to donate your organs, it's like if your family wants you to be given blood... they are not idiots and they will say what they need to say to get you what they think you need (and you'll be either dead or comatose... how convenient). "Of course Charles changed his mind at the last minute, despite the fact that he was completely intubated and delirious... oh yes, he wants his organs donated!!!"

 

Anyways, point is, to be safe, legally appoint a power of attorney for personal care (a "substitute decision maker") to someone you trust. Preferably that someone you trust is not a friend or a family member, but a professional attorney who could give a personal rats ass about you OR your family and who has demonstrated in past cases his or her absolute disregard for the wishes for others and only cares about the wishes expressly stated by you in your documents to him or her - in other words, someone who follows the letter of the law. The more callous and ruthless the attorney, the better a chance you have of having your own wishes fulfilled.

[canadameds]

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?

 

Hi,

 

Organ donation is the removal of the tissues of the human body from a person who has recently died, or from a living donor, for the purpose of transplanting. Organs and tissues are removed in procedures similar to surgery. People of all ages may be organ and tissue donors.

 

There are many more donations from deceased donors than living donors. The laws of different countries allow potential donors to permit or refuse donation, or give this choice to relatives. The popularity of donations varies substantially between countries.

[m30wc0w]

Well if they're disrespecting a body, you can be sure there'll be hell to pay for those students.

My biology teacher was recounting an incident that occured at the medical school of his university inwhich some students snuck into the morgue to jump rope with the cadavers intestines. They were caught (!!!) and were kicked out of the school and banned from all medical schools in both Canada and the United States.

[future_doc]

Hi,

 

Organ donation is the removal of the tissues of the human body from a person who has recently died, or from a living donor, for the purpose of transplanting. Organs and tissues are removed in procedures similar to surgery. People of all ages may be organ and tissue donors.

 

There are many more donations from deceased donors than living donors. The laws of different countries allow potential donors to permit or refuse donation, or give this choice to relatives. The popularity of donations varies substantially between countries.

 

I believe this issue was discussed recently on the forum and the information given, which was a surprise to me, is that the family decision overrules the prior consent form signed by the deceased.

[Edge]

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?

 

In Quebec, the immediate family has the final say in such a situation, so if an individual wishes to donate his/her organs upon death, its the spouse or the next ranking family member that decides. Plus, on the Medicare card where the signor signs their consent to donate their organs, they also acknowledge that they have informed their family, so if the individual hasn't informed his/her family, the consent would be considered null and void I imagine.

 

Now moving on to poking holes into your approach, for response 1, I find it too aggresive and unsympathetic and for response 3, I find it too unsympathetic also because your saying "too bad, btw, heres the number for a grief counsellor"

 

I would approach it by acknowlegding his loss, show some compassion and sympathy, and even treat him to coffee while you discussing the situation. During that moment, I would explain to him what it must mean to his wife and lastly, if he still refuses, either one, then it will be up to the hospital to decide.

 

Remember, the committees dont expect you to know everything, and clearly you have to put yourself in the situations and live it in your mind to fully comprehend it. No physician will forcefully do something.