Ethical Considerations of Organ Donation

             It is not uncommon for there to be medication shortages due to lack of financial incentives or availability, but how would that translate to another vital intervention- organ transplants. When there is a shortage of organs available for transplantation, what methods of maintaining the health of the public can be taken? One proposed method for this particular circumstance would be organ donation after cardiac death. Organ donation, in general, comes with its own variety of ethical considerations for all of those involved, and organ donation after cardiac death is no exception.

            This process is what is characterized as a controlled donation since the donating individual has decided to forgo any further life-sustaining treatment and has chosen to discontinue that life support under certain conditions that would allow for the immediate harvest of their organs after death pronouncement. This decision can also be made on behalf of a patient who lacks decision-making capacity by the patient’s authorized surrogate.

Unsurprisingly, donation after cardiac death is associated with many ethical concerns. The concerns include the specificity of the death pronouncement (how/when the death is pronounced for the donating patient), any potential biases or conflicts of interest housed by physicians in charge of overseeing the withdrawal of life support from a patient for subsequent organ harvesting, and the use of a surrogate decision maker.

Luckily, there are guidelines specific to organ donation and treatment that allow for an objective and thorough decision-making process by the supervising physicians. Firstly, physicians involved should adhere to any clinical criteria for identifying prospective donors and clarifying that the organs are likely to be suitable for transplantation. Physicians should also adhere to any specific institutional policies that govern donation after cardiac death. Perceived or actual conflicts can be avoided by differentiating health care professionals that provide end of life care from those that participate in organ retrieval; ensuring in this was that the members of the transplant team do not have any part in the decision to withdraw care. Additionally the decision to withdraw care must be made prior to the offer of organ donation. Informed consent must also be obtained from either the patient or surrogate, with an effort to be clear that the interventions made after death is pronounced is to preserve the organs to best improve the success of transplantation. Last, but certainly not least, standards for good clinical care and palliative practice must be implemented during the decision to withdraw life-sustaining interventions.

            Through these practices, ethical standards of maintaining the patient’s autonomy can be upheld while also practicing non-maleficence in the case of the patient wishing to withdraw care. Additionally, justice for the greater public is achieved through the obtainment of possible healthy organs for transplantation to patients in dire need. In this instance, ethical considerations must be acknowledged, and can also be navigated for the opportunity for greater patient health.  

Reference: 

“Organ Donation after Cardiac Death.” American Medical Association, https://www.ama-assn.org/delivering-care/ethics/organ-donation-after-cardiac-death.