Health Care Ethics

The organ retrieval from a deceased patient and transportation to a needy patient has remained one of the critical issues for the health care professionals and society at the global level. The critical issue of organ retrieval from the deceased patient is not only considered from a medical perspective but has another different aspect of emotional and sentimental values of the family of the dead patient. Both these aspects are notable and are relevant factors in deciding the ethical and moral outlook of the healthcare professionals in the implementation of compulsory organ retrieval from the deceased patient in those cases also where there is no such consent provided by the family. In this present essay, the arguments related to the organ retrieval from a disease patient with or without consent of family is analysed vis a vis the principles of autonomy, justice, beneficence and non- maleficence with the literature review of various thinkers and their respective arguments in a systematic manner. The essay will move forward to all the arguments and counter statements in the favour and against the motion of organ retrieval from the deceased patients with or without permission of the family.

The organ transplant has been one of the achievements of the medico-surgical procedures. Still, the application of this procedure to the needy patient is limited by the gap between the organ availability and the transportation of the same to the potential patient who will get benefit from the same (Council of Europe O. N. T., 2016). The current issue does not only involve complex medical phenomenon but is revolving around social, clinical, ethical, legal, economic, organizational factors which reflect upon the process critically (Council of Europe O. N. T., 2016). The inclusion of all the above- mentioned factor is also affected by the permission of the families of the deceased patients for organ retrieval in the western countries (Rosenblum et al., 2012).

The understanding of presumed consent and the opt-in system is significant in this argumentative approach towards the retrieval of organs of the deceased. Concept of presumed consent suggests the deceased patient would have consented for organ donations if asked, but it is ethically justifiable to retrieve the organ after death concerning the significance of public health (Fabre, 2014). Contrary to this presumed consent is the opt-in system. The concept of an opt-in system for procuring organs with the approval of the deceased or the next kin if the patient has died without consenting over the same (Nordfalk, 2016). This sort of system requires thorough information concerning the act of organ donation among the public as this is the only methodology to encourage the concept of organ donation.

On the other hand, as per the U.S. Department of Health and Human Services (2016), the presumption of the consent is morally controversial as it is considered that an important legal right of the patient is violated when the organ is retrieved from the deceased’s body. The patient has a legal right to not getting touched without their consent either they or alive or dead. Thus, autonomy is centralized when countering the matter of organ procurement. This legal right can be concerned in the case of emergency also where the patient is unconscious and the medical treatment is carried out without their permission considering, in general, the patient will not refuse the medical treatment in such urgency. Though there can be cases where the patient may refuse to such treatment given in an emergency. Having such strong confidence over the mistaken presumption of consent can lead to violation of the right of the deceased patients.

The ethical claim suggests that until and unless there is a strong confidence of no rejection of such consent by the majority of the patients, presumed consent cannot be legalized. This issue regarding the violation of right has not been demonstrated empirically in the case of organ donation (the U.S. Department of Health and Human Services 2016). On the other side, one of the arguments favouring this presumed consent states that having the consent of the deceased for organ retrieval is immaterial jotting the case of autopsy (Bolton, 2016). The autopsy is done in order to examine the cause of death if the reason is untraced prima facie and it does not require or provide any right to the kin of the deceased to approve the autonomy. Thus, the delivery of justice to the patient is controversial in this regard.

The most basic principle of beneficence is in consonance with the phase of documenting the decision regarding the organ donation (Lauerer, Kaiser and Nagel, 2016). It is crucial to understand that presumed consent for organ donation conflicts with the principles of non-maleficence, beneficence, justice or autonomy as the doctors are bound to fulfil all the moral obligation of doing the best care of the patient while they are alive. This principle of non-maleficence is a concern of serious nature in living donor transplants, as it posses the potential of doing medical harm to the donor (Dalal, 2015). The doctor has a professional duty of looking over the other before themselves as conveyed through the principle of beneficence. The fact of procuring organs from a deceased patient is obviously an exception to this principle as the doctors are fulfilling their professional obligation of saving another patient battling for life. The ethical approach towards the presumed consent has been considered to be more in consonance with the principle of nonmaleficence and delivers not only beneficence but justice as well. The act of presumed consent is more superior than explicit consent as it is more respectful than the principle of autonomy and it clearly goes against the wishes of the fewest number of people. Jotting the act of presumed consent, Prabhu (2019), stated that the evidence of the majority of people being in favour of explicit consent is a piece of evidence that the implementation of presumed consent in organ retrieval after the death of the patient will ensure a society constructed with the policy that nurtures the people's own choices and thus adhering to the Nuremberg Code.

One of the significant concerns in presumed consent for organ retrieval of a deceased patient includes the culture and religion of the patient and the nearest kin. The strong argument against the presumed consent for organ retrieval in respect of religion has been presented by Prabhu (2019) in his work. He has quoted the words of Pope Benedict XVI to criticize this act of presumed consent. Pope Benedict XVI said “… In these cases, informed consent is a precondition of freedom so that the transplant can be characterised as being a gift and not interpreted as a coercive or abusive act”. On this Austriaco urged to the catholic individuals and institutions “… must reject presumed consent and not cooperate with an unjust system of organ procurement” (Prabhu, 2019). Also, there have been various cases reported in which different culture has resisted this act of organ donation concerning their culture and religion (Li et al, 2019). The revert over this argument is based on the concept of the common good and the act of prioritizing the presumed consent over the consent of the deceased patients concerning it to be an act for the betterment of the public. As per Dalal (2015), the model of 'common good' suggests that the presumed consent is justified and subordinate to the broader interest of the society concerning the individual interests of the deceased patient and their family. Thus, justice to the patients and sentiments of the family concerning religion is also included in this argument.

As per Roels and Rahmel (2011), the believers of the presumed consent legislation admitted that the nations which have the explicit consent legislation regarding this organ retrieval have even shown that this particular strategy of improving organ donation is controversial and can even lead to diversion from more fruitful strategies.

The act of retrieving organ from a deceased patient is having different approaches and stands in different nations particularly in respect of such procurement against the wish of relatives after the death of the patient. Various authors and health care professionals advocate the concept of presumed consent to be of vital importance to increase the number of organ donors and help needy patients who are alive and battling for life. On the other hand, there are many perspectives which are entirely against the act of presumed consent for the procurement of organs from the deceased patient. This act is gauged on the various principles of healthcare professionals such as autonomy, justice, beneficence and non-maleficence. The thoughts of the critics are significant and contributing to the framing system of organ donation and organ retrieval which is in harmony with the legal, ethical, social and organisational factors. The legal rights, cultural and ethical factors affect the decision of organ donation to be taken by the relatives of the patients after death. The followers of presumed consent and opt-in consent has been strongly advocating their points with these principles vis-a-vis the act of presumed consent. Society has to make a significant choice concerning the thoughts of people.

References for Retrieval of Organs of Deceased Patients

Bolton, L. (2016). The Ethics of Deceased Organ Recovery without Requirements for Explicit Consent or Authorization. OPTN/UNOS Ethics Committee. Retrieved from: https://optn.transplant.hrsa.gov/media/1917/ethics_deceased_organ_recover_without_requirements_20160815.pdf

Council of Europe and O. N. T (2016). Newsletter Transplant. International Figures on Organ Donation and Transplantation. Volume 21. Madrid: Council of Europe and Organización Nacional de Trasplantes

Dalal, A. (2015). Philosophy of organ donation: Review of ethical facets. World J Transplant, 5(2), 44-51. DOI: 10.5500/wjt.v5.i2.44

Fabre J. (2014). Presumed consent for organ donation: a clinically unnecessary and corrupting influence in medicine and politics. Clin Med, 14(6), 567-71. DOI: 10.7861/clinmedicine

Lauerer, M., Kaiser, K., & Nagel, E. (2016). Organ Transplantation in the Face of Donor Shortage - Ethical Implications with a Focus on Liver Allocation. Visceral Medicine, 32(4), 278–285. https://doi.org/10.1159/000446382

Li, M.et al. (2019) Cultural barriers to organ donation among Chinese and Korean individuals in the United States: a systematic review. Transplant International, 32, 1001-1018. DOI:10.1111/tri.13439

Nordfalk F, Olejaz M, Jensen AMB, et al. (2016). From motivation to acceptability: a survey of public attitudes towards organ donation in Denmark. Transplant Res, 5(5). DOI: 10.1186/s13737-016-0035-2

Prabhu, P. (2019). Is presumed consent an ethically acceptable way of obtaining organs for transplant?. J Intensive Care Soc, 20(2), 92-97. DOI: 10.1177/1751143718777171

Roels L. and Rahmel A. (2011). The European experience, Transplant International, 24, 350-367. DOI: 10.1111/j.1432-2277.2011.01225.x

Rosenblum A. et al. (2012). The authority of next-of-kin in explicit and presumed consent systems for deceased organ donation: an analysis of 54 nations. Nephrology Dialysis Transplantation, 27 (6), 2533–2546. DOI: 10.1093/ndt/gfr619

U.S. Department of Health and Human Services. (2016). Ethics of Deceased Organ Donor Recovery. Retrieved from: https://optn.transplant.hrsa.gov/resources/ethics/ethics-of-deceased-organ-donor-recovery/

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