Legal and Ethical Issues Surrounding Organ Donation - Research Paper Example

? Organ Donation The essay aims to address a two-fold objective to wit to discuss organ donation; and (2) to identify the legal and/or ethical issue concerning organ donation. Organ Donation Introduction Organ donation or transplantation is the last resort and treatment of choice for patients with end-stage organ disease who face organ failure (Pozgar, 2010, 73). Organ donation is one of the miracles of modern medicine which has made it possible for people with organ failure to live longer and better. Organ donation is an emerging and growing trend in the field of health as a lot of people with organ failure seek this treatment for cure. Throughout the history, the image of organ donation has continued to improve due to better patient selection, improved clinical and operative management skills, and discovery of the immunosuppressant drug cyclosporine A that solves the problem of tissue and organ donation. Despite acceptance from majority of the public, organ donation has resulted in overarching of public interest, legalities, ethical consideration, and medical practice. Thus, the paper will seek to discuss the legal and ethical issues surrounding organ donation and the problem related to the mismatch of organ demand to supply. In addition, the paper will also discuss the dilemma of when should a patient be categorized as dead and candidate for organ donation, to whom shall organs be transplanted under the existing ethical and legal guidelines, and who will decide who will live or die. To address this issue, organ donation will be traced back on history and discussion of ethical and legal dilemmas will be made in terms of addressing three of the learning objectives from this course: analysis of the ethical principles of human dignity, compassion, non-malfeasance and social justice, discussion of the elements of autonomy, fidelity and confidentiality, and explanation of organ donation process and cultural diversity for ethical decision-making. History Organ donation started on the 1950s when surgeon Joseph Murray performed the first kidney transplant in 1954. It was followed by the first human heart transplant in 1967 by Christiaan Barnard, a surgeon from the Cape Town, South Africa. Organ donations during the 1950s were intense and angst-provoking. Surgeons were forced with the responsibility of choosing who among the patients will live or die by developing criteria for organ recipients in times when the organ supply were scarce. It was also at this time when the issue of organ rejection and inadequate and harmful antirejection medications were brought as an ethical dilemma due to unavailability of immunosuppressant cyclosporin A before 1978. As time goes by, issues concerning organ donation and transplantation have increased not only in quantity but also in complexity and diversity. Ethical issues in 1950s shifted to societal pressure for organ harvesting resulting from the significant difference between the global demand for organs and supply and the question of morality and legal definition of death during the 21st century. Kidney donation has declined since 2004 which led to conflicts between strategies designed to expand the organ supply through the use of expanded criteria donors and high-risk donors and the absence of adequate risk adjustment in the analysis of patient outcomes (Klein et al. 2010, 974). OPTN (Organ Procurement Transplantation Network) began to develop policies for living organ donation and transplantation to promote safety, education, data collection and oversight in 2006 through the Secretary of the U.S. Health and Human Services. Consent of patients and surrogates to organ donation became highlighted in 2007 when amendments in the UAGA (Uniform Anatomical Gift Act) were made that requires attending physician to consult with the patient or surrogate as early as possible to determine and follow the patient’s wishes in terms of transplantable organs (Truog, 2008, 1209). Organ donation overarched numerous ethical dilemmas and legal implications. Researchers continuously strive for innovation in the existing protocols to improve the function of transplants, expand the donor pool and match organ demand to supply, and reduce ethical, legal, and medical conflicts. Ethical Issues in Organ Donation Human dignity, compassion, non-malfeasance and social justice. Respect for the dying patient encompasses respect for human dignity (Bernat, 2008, 670). Human dignity is often compromised during organ donation due to differences in the perception of a respectful death. For instance, many are hesitant to organ donation because people believe that to die with dignity involves having intact organs. In addition, patient may also view death with dignity as the process of withdrawing from life-sustaining therapy and provision of palliative care (Bernat, 2008, 670). Family decision is also an important category for respect for human dignity. Family members feel that they are treated with dignity and respect if information about organ donation are presented in a consented and understandable manner. Conflict arises when the family has different perception of human dignity with the patient and when death is perceived differently from other members of the health care team. Thus, it is essential that the definition of death be clearly defined in order to provide a conceptual basis of death determination, explain the relationship between neurological and circulatory-respiratory grounds of death determination, and enhance the uniformity among legal boundaries of organ donation by proposing and justifying a standard model (Bernat et al. 2010, 963-964). Meanwhile, compassion is as important and sensitive issue as preservation of human dignity in patients and family members. Research in the United States has stated that some of the reasons why health team members are confronted with ethical dilemma in organ donation include emotional exhaustion and inadequate staff sensitivity and compassion (Jacoby & Jaccard, 2010, 53). At times, how a health care team member displays compassion towards donor patients affect the success or failure of organ donation. Nurses and physicians play a vital role in providing compassionate care by communicating with the patients’ families about organ donation and demonstrating supportive care. Members of the health care team must understand that the decision to donate one’s organ is emotionally-wrenching to the family members; thus, it is essential they allow families to take their time in donation decision, provide informational support about organ donation and brain death, offer emotional support, and enumerate instrumental support as these are all acts that would demonstrate a compassionate care towards a potential organ donor. Demonstrating compassionate care also encompassed non-maleficence because care rendered means no harm. In organ donation, surrogate consent sufficiently to protocols instituting extracorporeal membrane oxygenation (ECMO) in the donor after the declaration of death permit much more than invasive intervention which include the insertion of arterial catheters before death because they believe that these interventions are minimally harmful to the patient and that they benefit the organ recipient (Bernat, 2008, 670). However, this act of non-maleficence contradicts with the ethical principle of dying with dignity and respect. Emergence of ethical issues does not stop once decision is made. Another ethical issue arises when allocating donated organs to the needing population. Decision on who will decide patient who will live or die is the most pressing and stressful decision on the part of the jury or judges. Since 1950s, decision-makers have faced scarce health care resources and supply of organs and social justice is an ethical decision that decision-makers cannot overlook. First-come/ first served is an example of guideline for allocating organs to multiple recipients. First-come/ first served is based on the principle of fairness and is the closest guideline to achieve social justice in organ donation. For instance, if decision will be made based on medical entitlement method, the sickest patient will be prioritized in the list. However, patients chosen under this criterion have low success rate and the donated organ may not fit the deteriorating condition of the patient. If donated organs would be allocated in terms of social worth, decisions of the jury might be perceived as a result of value judgment as recipients are selected based on their self-destructive behavior or potential for rehabilitation. Consider the case of an alcoholic patient. Does the decision team have the right to say that the alcoholic patient is not worthy to live because he is an alcoholic? This method of allocating organs will only ignite more ethical issues because it discriminates and attacks the previous behavior of the individual to justify ineligibility to organ donation. Another option is the utilitarian-consequential perspective which is based on the longer term survival and higher quality of life. If this will be used to allocate organs to multiple recipients, how can the decision-makers determine who will survive longer? Just like the social worth method, the utilitarian-consequential perspective only raised ethical debates on how to distribute scarce resources. Elements of autonomy, fidelity and confidentiality. Obtaining a valid informed consent for organ donations from patients or surrogates before the withdrawal of life-sustaining treatment and in organ donation is a better approach to organ procurement that protects the autonomy of vulnerability of patients against possible abuse (Truog & Miller, 2008, 675). Consent from patients indicates their capability to decide on their own regarding organ donation. If there is a circumstance that the patient is mentally incapacitated, surrogates or families have the right to decide whether they would donate the organ or not. In addition, it is not wrong for cadavers to retrieve vital organs before death provided that there is consent and anesthesia is administered to preserve the dignity of patients. For a valid informed consent, it must be obtained from the patient or patient’s legal decision-makers with all the information related to organ donation such as risks, complications, operating room, relevant hospital personnel, and withdrawal of ventilatory or organ-perfusion support being communicated to the decision-maker (Reich et al. 2009, 2007). A valid informed consent characterized all the ethical requirements for organ donation because it respects the autonomy and desire of those who wish to donate the organs, respects human dignity, and maximizes the number and quality of organs available to those in need. Thus, the available evidence suggests that informed consent is associated with increased organ donation rates (Rithalia et al. 2009, 7). In addition, Jacoby & Jaccard (2010) stated that the provision of informational support regarding organ donation is the strongest predictor of consent to donate organs (p. 59). Meanwhile, informed consent must not only encompass autonomy or self-determination but fidelity and confidentiality. Fidelity is the act of keeping promises and this can be done by adhering to all the inclusion in the informed consent and providing care related to organ donation according to the standard protocol. Assurance of confidentiality must also be upheld because exposure of the identity of the recipients puts them at risk for individual who wanted to earn money through organ selling. The organ donation process and cultural diversity in ethical decision-making. The organ donation process starts with the selection of potential donors. Organ donors may include those who die trauma, stroke, primary brain tumor, cerebral anoxia, and even homicide and suicide victims with permission from a medical examiner (Westrick & Dempski, 2009, 132). Screening is done to detect ineligible candidates for organ donation such as those with transmissible disease. Donors are then classified as cadaveric organ donor, living related organ donor, or living related organ donor. Once preliminary criteria have been met, a health care team member or family member will alert the OPO for potential organ or tissue donation. Prior to donation, coordinators will evaluate donor by obtaining information about the time and cause of death, past medical history, and immediate medical condition (Westrick & Dempski, 2009, 133). Medical contraindications are ruled out and families are offered with the option for donation. Information about organ donation will be discussed and an informed consent will be obtained. The decision to donate or receive an organ varies among nations, culture, and religion. For instance, Singapore and Belgium encouraged kidney donation with evidence from the statistics stating an increased from 18.9 to 41.3 per million population per year over a three year period from Belgium and 4.7 to 31.3 per million population increased over a three year period from Singapore (Rithalia et al. 2009, 2-3). The culture of a country, particularly the religion, also affects organ donation. For instance, the Catholic favors organ donation as they value organ transplantation as a service of life. On the contrary, Jehovah’s Witnesses neither donate nor receive organs in respect to the gift originally given by their God (Rithalia et al. 2009, 4). Legal Issues The most common legal issues surround the topics regarding confidentiality and informed consent. One of these legal issues concerning confidentiality is the Uniform Anatomical Gift Act (UAGA). Under this legislation, a person can make decision to donate organs at the time of death or a potential can carry an anatomical donor card (Pozgar, 2010, 75). The act also encompasses the right of the right to privacy of the donor and his or her family. Legality issues arise because there are deviations of this act or additional laws dealing with donation in some states and country. Conflicts in the congruency of the law and in respecting the authority of next of kin may also be noted because the act supports the donation by will which becomes effective immediately on the death of the testator and is legally valid and effective even without the probate if acted on in good faith (Pozgar, 2010, 75). Even with the implementation of this law, the physician still seek the permission of the surviving family members when in fact, there is no need to ask permission due to the presence of legal documentation. In 2006, the UAGA provisioned to strengthen the language barrier in order to firmly establish the decision to make or refuse donations. Resources The Organ Procurement and Transplantation Network (OPTN) serves as one of the resources for organ donation. OPTN has United Network for Organ Sharing (UNOS) which contains the name of the candidates waiting for organ donation (Westrick & Dempski, 2009, 132). OPTN is also responsible for the policies related to procurement and transplantation. All organ procurement and transplant centers in US must be members of Organ Procurement Organizations (OPOs). OPOs allocate organs to be donated in an equitable manner. Together with the OPTN, OPOs set the acceptable criteria for a donor and make studies and researches that would improve transplantation in the country. OPOs also assure that confidentiality of information are kept to maximum (except in paired donation) to protect vulnerable persons from abuse and possible monetary again derived from selling organs. References Bernat, J.L. (2008). The Boundaries of Organ Donation after Circulatory Death. The New England Journal of Medicine, 359(7): 669-671. Bernat, J.L. et al. (2010). The circulatory–respiratory determination of death in organ donation. Critical Care Medicine, 38(3): 963-970. Jacoby, L. & Jaccard, J. (2010). Perceived Support among Families Deciding About Organ Donation for Their Loved Ones: Donor Vs. Non-Donor Next of Kin. American Association of Critical-Care Nurses: 52-62. Klein, A.S. et al. (2010). Organ Donation and Utilization in the United States, 1999–2008. American Journal of Transplantation, 10(2): 973-986. Pozgar, G.D. (2010). Contemporary Ethical Dilemmas. Legal and Ethical Issues for Health Professionals (2nd ed.) (p. 47-96). Massachusetts: Jones & Bartlett Publishers, LLC. Reich, D.J. et al. (2009). ASTS Recommended Practice Guidelines for Controlled Donation after Cardiac Death Organ Procurement and Transplantation. American Journal of Transplantation, 9: 2004-2011. Rithalia, A. et al. (2009). Impact of presumed consent for organ donation on donation rates: a systematic review. British Medical Journal: 1-8. Truog, R.D. (2008). Consent for Organ Donation — Balancing Conflicting Ethical Obligations. The New England Journal of Medicine, 358(12): 1209-1211. Truog, R.D. & Miller, F.G. (2008). The Dead Donor Rule and Organ Transplantation. New England Journal of Medicine, 359(7): 674-675. Westrick, S.J. & Dempski, K. (2009). Organ and Tissue Donation and Transplantation. Essentials of Nursing Law and Ethics (p. 130-136). Massachusetts: Jones & Bartlett Publishers, LLC. Read More