Opt-out paradigms for deceased organ donation are ethically incoherent

2021 ◽  
pp. medethics-2021-107630
Author(s):  
G M Qurashi
Keyword(s):  
Organ Donation ◽  
Organ Procurement ◽  
Organ Donor ◽  
Organ Shortage ◽  
Opt Out ◽  
Deceased Organ Donation ◽  
The Dead

The Organ Donation Act 2019 has introduced an opt-out organ donor register in England, meaning that consent to the donation of organs upon death is presumed unless an objection during life was actively expressed. By assessing the rights of the dead over their organs, the sick to those same organs, and the role of consent in their requisition, this paper interrogates whether such paradigms for deceased organ donation are ethically justifiable. Where legal considerations are applicable, I focus on the recent changes in England as a case in point; however, this paper ultimately challenges the justifiability of opt-out systems in any form, concluding that ethical solutions to organ shortage do not lie in opt-out systems of deceased organ procurement.

Lives and choices, give and take: Altruism and organ procurement

2017 ◽  
Vol 26 (2) ◽  
pp. 587-597 ◽  
Author(s):  
Vicky Thornton
Keyword(s):  
Organ Donation ◽  
Positive Impact ◽  
Organ Procurement ◽  
Statistical Evidence ◽  
Opting Out ◽  
Procurement Policy ◽  
Opt Out ◽  
Utilitarian Approach ◽  
Cadaveric Organ

In 2015, Wales introduced a deemed consent: soft opt-out system for organ procurement in order to address the chronic shortage of organs for transplant. Early statistical evidence suggests that this has had a positive impact on cadaveric organ donation. Such a system for procurement has previously been dismissed by the Organ Donation Taskforce, who suggested that opting out could potentially undermine the concept of donated organs as gifts and this could then negatively impact the number of organs offered for transplant. Considerable weight was placed upon the need to retain the altruistic gift element associated with an opt-in system. This article will consider the role of altruism in an organ procurement policy. A broad utilitarian approach will be taken when putting forward the arguments in favour of adopting a weak altruism position in a soft opt-out system for procurement with a combined registry.

scholarly journals Should the family have a role in deceased organ donation decision-making? A systematic review of public knowledge and attitudes towards organ procurement policies in Europe

2021 ◽  
Author(s):  
Alberto Molina Pérez ◽  
Janet Delgado ◽  
Mihaela Frunza ◽  
Myfanwy Morgan ◽  
Gurch Randhawa ◽  
...  
Keyword(s):  
Decision Making ◽  
Organ Donation ◽  
Organ Procurement ◽  
Public Knowledge ◽  
The Public ◽  
Organ Retrieval ◽  
Knowledge And Attitudes ◽  
The Family ◽  
Deceased Organ Donation

Goal: To assess public knowledge and attitudes towards the role of the family in deceased organ donation in Europe. Methods: A systematic search was conducted in CINHAL, MEDLINE, PAIS Index, Scopus, PsycINFO, and Web of Science. These databases were last searched on December 15th, 2017. Eligibility criteria were empirical studies conducted in Europe from 2008 to 2017 and addressing either knowledge or attitudes by the public towards the consent system, including the involvement of the family in the decision-making process, for post-mortem organ retrieval. Each record was screened by two or more independent reviewers in three phases. Data collection from each report was performed by two or more independent reviewers. Results: Of the 1,482 results, 467 reports were assessed in full-text form, and 33 were included in this synthesis. Studies show that a majority of the public support the family′s involvement in organ retrieval decision-making and, in particular, their role as surrogate decision-maker when the deceased has expressed no preference. Conclusions: A common conceptual framework and validated well-designed questionnaires are needed to address the role of the family in future studies. The findings should be considered in the development of Government policy and guidance regarding the role of families in deceased organ donation.

scholarly journals Hospital-based organ donation memorial ceremony: a grounded theory pilot study

2015 ◽  
Vol 4 (3) ◽  
pp. 1
Author(s):  
Charles Calhoun Reed ◽  
Elma I Fonseca ◽  
Regina I Reed ◽  
Stacy Foremski ◽  
Sara L Gill
Keyword(s):  
Grounded Theory ◽  
Pilot Study ◽  
Organ Donation ◽  
Organ Procurement ◽  
Social Process ◽  
Organ Donor ◽  
Hospital Staff ◽  
Tree Planting ◽  
Individual Level ◽  
Organ Procurement Organizations

Objective: Various types of organ donation memorials, to include tree planting, rose garden memorials, candle lighting, donor memorial wall events are conducted throughout the year primarily by organ procurement organizations (OPOs). Although the benefits of such events have not been explored there has been continued interest by hospital staff and administrators to host such events. The purpose of this grounded theory pilot study was to describe the process of healing that a hospital-based organ donation memorial ceremony creates at the individual level and organ donation awareness and advocacy at the community level.Methods: The researchers interviewed nine organ donor family members who were invited to attend a hospital-based organ donation memorial ceremony at one Level I Trauma Center located in South Texas.Results: A 4-stage social process, “makes the hole in the heart smaller”, was identified from the qualitative interview data. Participants journeyed through a four stage process to make the hole in their hearts smaller. The four stages are: choosing to attend, being able to connect, keeping the memory alive and knowing something good came from it. As participants moved between stages their meaning for attendance changed. Families shifted from personal grieving and needing support to supporting other donor families and in the process became advocates for organ donation.Conclusions: The findings from this study validate the benefits of hospital-based organ donation memorial ceremonies. Families reported these ceremonies support their decision to donate, while also providing a means of continued emotional support throughout their grief process. The memorial event provides a safe venue for organ donor families to connect and share with others who have had a similar experience, while acknowledging their loved ones gift of life. Hospital-based organ donation memorial ceremonies and the permanent memorial structure increase awareness of organ donation for the community of donor families, hospital visitors and hospital staff.

scholarly journals Knowledge and attitude of law, medicine, and mass-communication students towards deceased organ donation

2020 ◽  
Vol 8 (1) ◽  
pp. 22
Author(s):  
Pragya Paneru ◽  
Shyam S. Budhathoki ◽  
Samyog Uprety ◽  
Birendra K. Yadav ◽  
Rashmi Mulmi ◽  
...  
Keyword(s):  
Organ Donation ◽  
Organ Failure ◽  
Organ Transplantation ◽  
Mass Communication ◽  
Organ Donor ◽  
Cross Sectional Study ◽  
World Health ◽  
Cross Sectional ◽  
Deceased Organ Donation ◽  
Knowledge And Attitude

Background: With the global increase in the incidence organ failure and subsequent advancement in the medical technology, organ transplantation is growing as the best choice of treatment among the patients with various kinds of organ failure. However, the rate of deceased organ donation is relatively low in South-East Asia regions, including Nepal. This has created a mismatch between the demand and supply of organs for transplantation. World Health Organization encourages organ transplantation from a deceased organ donor as there is no risk to the donor. Thus, this paper aimed to assess knowledge and attitude of literate group specifically towards deceased organ donation.Methods: This was a cross-sectional study conducted among 299 students selected conveniently from medicine, law, and mass communication streams from 9 different colleges (3 colleges from each stream) of Kathmandu. Data was collected through a self-administered questionnaire. Knowledge level was classified into three different categories based on obtained scores and attitude was analyzed based on five-point Likert scale.Results: Almost half (48.8%) of the respondents while only 7% had high level of knowledge on the organ donation and transplantation. Similarly, 95% of the people had positive attitude towards organ donation. However, there was a weak correlation between knowledge and attitude of the respondents. None of the respondents carried an organ donation card.Conclusions: There is a need to plan robust strategies to educate people on organ donation so that they can make pragmatic decisions to register their names for deceased organ donation.

The ‘opt-out’ approach to deceased organ donation in England: A misconceived policy which may precipitate moral harm

2019 ◽  
Vol 14 (2) ◽  
pp. 63-69
Author(s):  
Tobias K Cantrell
Keyword(s):  
Organ Donation ◽  
Public Awareness ◽  
Recent Attempt ◽  
Individual Autonomy ◽  
Presumed Consent ◽  
Opt Out ◽  
The Family ◽  
Deceased Organ Donation ◽  
Tissue Act ◽  
Human Tissue Act

In an effort to solve the shortage of transplantable organs, there have been several proposals to introduce an opt-out approach to deceased organ donation in England (also termed ‘deemed’, or ‘presumed’ consent). In seeking to enact the so-called ‘opt-out proposal’ via an amendment to the Human Tissue Act 2004, The Organ Donation (Deemed Consent) Bill 2017–19 represents the most recent attempt at such legal reform. Despite popular calls to the contrary, I argue in this paper that it would be premature for England, or, indeed, any country, to adopt an opt-out approach at this time. Not only is the available evidence inconclusive on whether introduction of the opt-out proposal would increase the supply of transplantable organs (a common misconception), but there is also a chance that doing so might bring about an otherwise avoidable moral harm through an unjustified interference with individual autonomy. I maintain that the resources required to change the law to such effect would be better expended on alternative, provenly efficacious and less contentious mechanisms for increasing the supply of transplantable organs, such as: improving communication with the family of the deceased, developing infrastructure, raising public awareness and enhancing staff training, attitudes and understanding towards organ donation.

scholarly journals Short-term impact of introducing a soft opt-out organ donation system in Wales: before and after study

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e025159 ◽  
Author(s):  
Jane Noyes ◽  
Leah McLaughlin ◽  
Karen Morgan ◽  
Philip Walton ◽  
Rebecca Curtis ◽  
...  
Keyword(s):  
Organ Donation ◽  
Organ Donor ◽  
P Value ◽  
Short Term ◽  
Consent Rate ◽  
Potential Organ Donor ◽  
Opt Out ◽  
Significant Difference ◽  
Before And After ◽  
Donor Numbers

ObjectivesTo determine the short-term impact of a soft opt-out organ donation system on consent rates and donor numbers.DesignBefore and after observational study using bespoke routinely collected data.SettingNational Health Service Blood and Transplant.Participants205 potential organ donor cases in Wales.InterventionsThe Act and implementation strategy.Primary and secondary outcomesConsent rates at 18 months post implementation compared with 3 previous years, and organ donor numbers 21 months before and after implementation. Changes in organ donor register activity post implementation for 18 months.ResultsThe consent rate for all modes of consent was 61.0% (125/205), showing a recovery from the dip to 45.8% in 2014/2015. 22.4% (46/205) were deemed consented donors: consent rate 60.8% (28/46). Compared with the 3 years before the switch there was a significant difference in Welsh consent rates (χ2 p value=0.009). Over the same time period, rest of the UK consent rates also significantly increased from 58.6% (5256/8969) to 63.1% (2913/4614) (χ2 p value<0.0001), therefore the Wales increase cannot be attributed to the Welsh legislation change. Deceased donors did not increase: 101 compared with 104. Organ donation registration increased from 34% to 38% with 6% registering to opt-out.ConclusionThis is the first rigorous initial evaluation with bespoke data collected on all cases. The longer-term impact on consent rates and donor numbers is unclear. Concerns about a potential backlash and mass opting out were not realised. The move to a soft opt-out system has not resulted in a step change in organ donation behaviour, but can be seen as the first step of a longer journey. Policymakers should not assume that soft opt-out systems by themselves simply need more time to have a meaningful effect. Ongoing interventions to further enhance implementation and the public’s understanding of organ donation are needed to reach the 2020 target of 80% consent rates. Further longitudinal monitoring is required.

A Qualitative Study of Turning Points or Aha! Moments in Older Adults’ Discussions About Organ Donation

2018 ◽  
Vol 28 (3) ◽  
pp. 207-212 ◽  
Author(s):  
Kimberly Downing ◽  
Linda L. Jones
Keyword(s):  
Older Adults ◽  
Qualitative Study ◽  
Organ Donation ◽  
Organ Procurement ◽  
Turning Points ◽  
Age Groups ◽  
Organ Donor ◽  
Younger Age ◽  
Donation Process ◽  
Dialogue Process

Introduction: Older adults (50-70 years old) have lower organ donor registration rates than younger adults. Older adults have different informational needs and donor registration behavior than younger age groups. Objective: The objective of this qualitative study was to understand insights of older adults about organ donation to effectively address the barriers to becoming an organ donor. This study identified turning points as “Aha!” moments that occurred during a dialogue intervention where older adults discussed benefits, barriers, and process to organ donation. Setting and Participants: Dialogues were held with small groups of older adults in 11 communities in a Midwestern organ procurement organization service area. Participants were positive to organ donation, but not registered as an organ donor. Methods/Approach: Qualitative analysis of verbatim comments from the dialogue and a follow-up survey were used to examine turning points or “Aha!” moments of participants’ decision-making about organ donation and organ donor registration. Findings: Twenty-one separate in-depth dialogues were conducted with 198 participants, with mean age of 60.57 years. There were 2757 separate comments coded with 465 of the comments (17%) identified as providing Aha! moments during the dialogue. Three themes include benefits of organ donation (30%), barriers about organ donation (39%), and organ donation process (31%). Discussion: The research identified moments in the dialogue where possible learning about organ donation may have occurred. After participation in the dialogue process, there was an increase in intent to register to be an organ donor, organ donation discussion with family and friends, and organ donor registration.

scholarly journals Promoting organ donation through Basic Life Support Training –outcomes from the #conversations study.

2020 ◽  
Author(s):  
Caroline Wroe ◽  
Natasha Newell ◽  
Yitka Graham ◽  
Marcus Diamond ◽  
Michael O'Malley ◽  
...  
Keyword(s):  
Organ Donation ◽  
Basic Life Support ◽  
Life Support ◽  
Cultural Influences ◽  
Organ Donor ◽  
Educational Interventions ◽  
Recent Change ◽  
Baseline Survey ◽  
Opt Out ◽  
The Impact

Abstract Background: More than 6000 people are waiting for an organ transplant in the UK. Although a recent change in organ donor legislation to an opt out system is hoped to address this disparity expert review highlights that ‘opt out’ is only one of several factors that impact organ donation rates. Studies show that ethnicity, religion and cultural influences impact opinions towards organ donation. The importance of education is well established and interpersonal educational interventions have been shown to be more effective than mass media approaches to changing behaviour around organ donation. This study evaluates the impact of an educational intervention delivered with Basic Life Support training prior to the change in legislation to positively influence views on organ donation.Methods: An educational film promoting organ donation was developed from patient’s stories, evaluated, reviewed and embedded into BLS training. All staff attending BLS training were invited to participate in the study, complete a baseline survey, watch the film and complete another survey 3-5 working days after the training.Results: During the study period 338 attended BLS training, 8 out of 10 agreed to participate in the study, 6 out of 10 stayed behaving for the intervention and 3 out of 10 completed all stages of the study. Support for organ donation was almost universal in the baseline survey and of those who completed the study, >9 out of 10 felt the intervention had helped them understand the need for organ donation and 1 in 2 had subsequently discussed organ donation with their family and friends. 1 in 4 did not support the forthcoming change in organ donation legislation.Conclusions: A brief targeted intervention delivered through BLS training is effective in promoting discussion and improves support for organ donation. The mandatory nature of BLS training reduces bias in engagement and offers huge potential for delivery of a limited intervention around organ donation at pace and scale. Further understanding of NHS staff awareness of and opinions to the change in organ donation legislation is warranted. Trial Registration#conversations was prospectively registered with the ISRCTN on 23/01/2019.ISRCTN 36338010IRAS project ID 233611

Chaplain “DOs and DON’Ts” on Organ Donation

2018 ◽  
Vol 43 (7) ◽  
pp. 1-2
Author(s):  
Jozef Zalot ◽  
Keyword(s):  
Organ Donation ◽  
Organ Procurement ◽  
Family Members ◽  
Organ Donor ◽  
Organ Donors ◽  
Vital Organ ◽  
Course Of Action ◽  
Donation Process ◽  
Organ Procurement Organizations ◽  
The Relationship

This guide was developed in collaboration with LifeCenter Organ Donor Network (Cincinnati, OH) to offer chaplains a framework for the best possible course of action when they provide spiritual care to family members of patients who are potential vital organ donors. Some organ procurement organizations (OPOs) may want to control the donation process. They are thus hesitant to invite in—let alone collaborate with—any “outsiders” who they believe might undermine the likelihood of procuring vital organs. So how should a chaplain respond when ministering to potential vital organ donors and their families? Should they speak with family members about donation? What should they say? Do OPOs want chaplains to speak with family members? Should there be limits to these conversations? This can be a touchy area, because vital organ donation necessarily entails the death of the patient. This makes the relationship between chaplains and OPOs sometimes strained.

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