Modified mandated choice for organ procurement

Journal of Medical Ethics

Volumn 29, Issue 3, 2003, Pages 157-162

  Chouhan, Poonam ^a   Draper, H ^a  

^a UNIVERSITY OF BIRMINGHAM   (United Kingdom)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; CADAVER DONOR; HEALTH CARE POLICY; HEALTH EDUCATION; HUMAN; HUMAN RIGHTS; MEDICAL DECISION MAKING; MEDICOLEGAL ASPECT; ORGAN DONOR; ORGAN TRANSPLANTATION; PUBLICATION; UNITED KINGDOM;

HEALTH CARE AND PUBLIC HEALTH;

CADAVER; CHOICE BEHAVIOR; FAMILY; HEALTH EDUCATION; HEALTH POLICY; HUMANS; MANDATORY PROGRAMS; PERSONAL AUTONOMY; RELIGION AND PSYCHOLOGY; TISSUE AND ORGAN PROCUREMENT; TISSUE DONORS;

EID: 0038127134     PISSN: 03066800     EISSN: None     Source Type: Journal    
DOI: 10.1136/jme.29.3.157     Document Type: Article

References (53)

1. Figures from UK Transplant's web site, for instance, state that in 2000, although a total of 1823 cadaveric and live) kidney donations were performed the waiting list at the close of the year had 6284 patients; 709 liver transplants were performed but 175 patients remained on the waiting list; 250 heart or heart/lung transplants were performed but 289 patients were still waiting for a transplant, and 98 lung transplants were performed but 205 patients were still awaiting transplant.
2. Council of Europe. Convention on Human Rights and Biomedicine. Oriedo, Spain: 1997 Apr 4. Article 21: Prohibition of financial gain states: "The human body and its parts shall not, as such, give rise to financial gain".
3. For instance, UK Transplant reported on its Web site that the number of live kidney donations had risen from 89 in 1991 to 336 in 2000.
4. For example, for kidney donors, major complications for the donor are rare, and the mortality rate is about 0.03%. See: British Medical Association BMA) Medical Ethics Committee (MEC). Organ donotion in the 21st century: time for a consolidated approach. London: BMA, 2000: 10.
5. For example, although liver segments may regenerate, lung segments do not, and donors may suffer from respiratory problems. See: UNOS. Living donation - an overview on the UNOS website www.unos.org.
6. For instance, the Unrelated Live Transplantation Regulatory Authority (ULTRA) is at the time of writing considering the possibility of permitting paired donation and altruistic donation by strangers, and this consideration has been incorporated into the recently announced public consultation on the review of the law governing human tissue transplantation in the UK.
7. See reference 4: 5 where, for instance, it is pointed out that very few of those who die are actually suitable organ donors.
8. Human Tissue Act 1961: section 1(2). London: Her Majesty's Stationery Office, 1961.
9. British Medical Association (BMA) Medical Ethics Committee (MEC). Organ donation in the 21st century: time for a consolidated approach. London: BMA, 2000.
10. Price D. Legal and ethical aspects of organ transplantation. Cambridge: Cambridge University Press, 2000: 86 cites a Council of Europe survey that 23 European countries operated presumed consent systems for organ procurement.
11. See reference 10: 89.
12. See reference 10: 90.
13. It is likely to make a reappearance in the recently announced review of the law on human tissue transplantation in the UK
14. Council on Ethical and Judicial Affairs. Strategies for cadaveric organ procurement. JAMA 1994;272:809-12.
15. Kings Fund Institute. A question of give and take: improving the supply of donor organs for transplantation. London: Kings Fund Institute, 1994:37-42.
16. Erin C, Harris J. Presumed consent or contracting out? J Med Ethics 1999;25:365-6: 365.
17. Redfern M, Keeling JW, Powell E. The Royal Liverpool Children's inquiry report. Liverpool: The Royal Liverpool Children's Inquiry, 2001: 367, 369-375.
18. It is, however, expected to be one of the options explored in the public consultation of the review of the law governing the transplantation of human tissue in the UK.
19. Kings Fund Institute. A question of give and take: improving the supply of donor organs for transplantation. London: Kings Fund Institute, 1994:39-40.
20. Harris J. The value of life. London: Routledge, 1985: 118-19.
21. Menzel PT. The moral duty to contribute and its implications for organ procurement policy. Transplant Proc 1992;24:2175-8.
22. For more information about the kind of policies required to implement mandated choice, see: Dennis J, Hanson P, Hedge E, et al. An evaluation of the ethics of presumed consent and a proposal based on required response. Washington DC: United Network for Organ Sharing, 1993;
23. Herz SE. Two steps to three choices: a new approach to mandated choice. Camb Q Healthc Ethics 1999;8:340-7;
24. Spital A. Mandated choice for organ donation: time to give it a try. Ann Intern Med 1996:125:66-9;
25. Spital A. The shortage of organs for transplantation: where do we go from here? N Engl J Med 1991;325:1243-6.
26. Veatch RM. Death, dying and the biological revolution. New Haven: Yale University Press, 1976: 272-3. Here Veatch did not use the term "mandated choice" but spoke instead of "routine and organised solicitation of donation".
27. See reference 22: Spital A: 1996: 66-9, and Spital A: 1991: 1243-6.
28. See also: Spital A. Mandated choice: a plan to increase public commitment to organ donation. JAMA 1995;273:504-6;
29. Spital A. Mandated choice: the preferred solution to the organ shortage? Arch Intern Med 1992;152:2421-4.
30. See reference 24: Spital A: 1992: 2421-4.
31. See reference 22: Dennis J, Hanson P, Hedge E, et al: 1993.
32. See reference 4: 20-21.
33. To get around the contradiction inherent in the phrase "compulsory or mandatory donation", John Harris, in The value of life, London: Routledge, 1985: 119, used the phrase "transplant orders". We have chosen to stick with the phrase "mandatory donation" because this formulation made it easier for us to contrast mandatory choice and donation. We acknowledge the inherent contradiction in the choice of terms here.
34. Erin CA, Harris J. AIDS: Ethics, justice and social policy. J Appl Philos; 1993;10:165-73;
35. Harris J, Holm S. If only AIDS were different. Hastings Cent Rep 1993;23:6-12;
36. Erin CA. Is there a right to remain in ignorance of HIV status? In: Bennett R, Erin CA, eds. HIV and AIDS: testing, screening and confidentiality. Oxford: Oxford University Press, 1999: 251-66. It should be noted that these papers also argue for or assume reciprocity: compulsory treatment/testing must be matched by a social willingness to help shoulder some of the burdens faced by those who contract the virus.
37. Dworkin G. The theory and practice of autonomy. Cambridge: Cambridge University Press, 1988:8.
38. See Boddington P. Organ donation after death - should I decide, or should my family? J Appl Philos 1998;15:69-81.
39. See reference 15: 30; Dworkin G, Kennedy I. Human tissue: rights in the body and its parts. Med Law Rev 1993;1:294.
40. Nuffield Council on Bioethics. Human tissue - ethical and legal issues. London: Nuffield Council on Bioethics, 1995: 68.
41. Grubb A. "I, me, mine": bodies, parts and property. Med Law Int 1998;3:299-317.
42. Steiner H. Property in the body: a philosophical perspective. In: Stern K, Walsh P, eds. Property rights in the human body. London: Centre of Medical Law and Ethics - Kings College London, 1997: 1.
43. Paradoxically, arguments against the body being seen as proper have been made to protect those who might come under pressure to sell various body parts. The desire to balance the public interest in not permitting trade in organs with the interest individuals are thought to have in making decisions about the disposal of their bodies after their death, has given rise to a legal situation whereby"... at the moment property is created the owner of it must inevitably have ceased to exist!": reference 10: 132.
44. See for instance, Elizabeth Adams v Julian James Lewis (Administrator of the Estate of Frank Adams, Deceased) (2001) where it was held that reasonable provision had not been made by Mr Adams for his wife Elizabeth, and the amount to be paid to her from his estate was therefore considerably increased.
45. Here we are referring to moral not legal interests. In most states the relatives do not have legal ownership as such.
46. Mill JS. On liberty. London: Penguin Books, 1982: 68.
47. See Feinberg J. Harm to others. The moral limits of the criminal law [vol 1]. New York: Oxford University Press, 1984: 26-7.
48. See reference 21: 2175, adapted from Menzel, and Beauchamp TL, Childress JF. Principles of biomedical ethics [4th ed]. Oxford: Oxford University Press, 1994: 266.
49. We agree, however, with Tom Farsides that there are significant psychological barriers to donation that have to be addressed and that without addressing these barriers, requiring people to choose might be counterproductive. See his excellent paper: Farsides T. Winning hearts and minds: using psychology to promote voluntary organ donation. Health Care Anal 2000;8:101-21.
50. Charlesworth M. Bioethics; in a liberal society. Cambridge: Cambridge University Press, 1993: 14.
51. For a full account of the Spanish system see reference 4: 22, or the web site of the Organizacion Nacional de Trasplantes (ONT) on http://www.msc.es/ont/ing/home.htm. We stress that there is much more to the Spanish system than the idea we have borrowed from it and modified.
52. We accept that this runs counter to the emerging tradition of impartial information giving and counselling. Our point is that this approach is justified by appeals to the greater good.
53. It could, of course be sheer small-mindedness but we are hoping for the best in human nature here.