Is providing elective ventilation in the best interests of potential donors? (original) (raw)
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A critical controversy surrounds the type of allowable interventions to be carried out in patients who are potential organ donors, in an attempt to improve organ perfusion and successful transplantation. The main goal is to transplant an organ in conditions as close as possible to its physiological live state. "Elective ventilation" (EV), that is, the use of ventilation for the sole purpose of retrieving the organs of patients close to death, is an option which offsets the shortage of organ donation. We have analyzed the legal context of the dying process of the organ donor and the feasibility of EV in the Italian context. There is no legal framework regulating the practice of EV, neither is any real information given to the general public. A public debate has yet to be initiated. In the Italian cultural and legislative scenario, we believe that, under some circumstances (i.e., the expressed wishes of the patient, even in the form of advance directives), the use of EV does not violate the principle of beneficence. We believe that the crux of the matter lies in the need to explore the real determination and will of the patient and his/her orientation towards the specific aim of organ donation.
Elective Ventilation and the (Bio)Politics of Organ Donation.
This essay comments on the British Medical Association’s recent suggestion that protocols for Elective Ventilation might be revived in order to increase the number of viable organs available for transplant. I suggest that the proposed revival results, at least in part, from developments in the contemporary political landscape notable the decreasing likelihood of an opt-out system for the UK’s Organ Donor Register. I go on to suggest that Elective Ventilation is unavoidably situated within complex debates surrounding the epistemology and ontology of death. Such questions cannot be settled a priori by medical science, bioethics or philosophical reflection. As Radcliffe-Richards suggests the determination of death has become a moral question and therefore now extends into the political arena. I argue for the conclusion that Elective Ventilation, and wider debates about organ donation and the constitution of the organ donation register, are matters of ‘biocitizenship’ and must, therefore, be addressed as ‘biopolitical’ questions.
BioMed Research International, 2014
A critical controversy surrounds the type of allowable interventions to be carried out in patients who are potential organ donors, in an attempt to improve organ perfusion and successful transplantation. The main goal is to transplant an organ in conditions as close as possible to its physiological live state. "Elective ventilation" (EV), that is, the use of ventilation for the sole purpose of retrieving the organs of patients close to death, is an option which offsets the shortage of organ donation. We have analyzed the legal context of the dying process of the organ donor and the feasibility of EV in the Italian context. There is no legal framework regulating the practice of EV, neither is any real information given to the general public. A public debate has yet to be initiated. In the Italian cultural and legislative scenario, we believe that, under some circumstances (i.e., the expressed wishes of the patient, even in the form of advance directives), the use of EV does not violate the principle of beneficence. We believe that the crux of the matter lies in the need to explore the real determination and will of the patient and his/her orientation towards the specific aim of organ donation.
Using Mentally Incompetent Adults as Living Organ Donors: Widely Diverging Regulations in Europe
European Journal of Health Law, 2012
With the case of Belgium as a negative example, this paper will evaluate the legitimacy of using mentally incompetents as organ sources. The first section examines the underlying moral dilemma that results from the necessity of balancing the principle of respect for persons with the obligation to help people in desperate need. We argue for the rejection of a radical utilitarian approach but also question the appropriateness of a categorical prohibition. Section two aims to strike a fair balance between the competing interests at stake and to define the conditions under which organ harvest from mentally incompetents might be morally acceptable. To this end, we morally assess the main requirements that have been put forward to allow organ removal from incompetent donors. We conclude that the current Belgian legislation is far too permissive and that national regulations that do not permit the harvest of non-regenerable organs from mentally incompetents in exceptional circumstances are too restrictive. On the basis of this discussion, we propose a number of guiding principles for decisionmaking in this area.
The Ethics of Elective (Non-Therapeutic) Ventilation
Bioethics, 2000
Elective ventilation (EV) is ventilation applied, not in the interest of patients, but in order to secure transplantable organs. It carries with it a small risk that patients who would otherwise have died will survive in a persistent vegetative state. Is EV ever justifiable? We argue: (1) The only thing which can justify exposing patients to risk not taken for their benefit is their consent, and we cannot rely on implied consent or third party consent in the case of EV. Thus, absent explicit consent of patients, EV is not justifiable. (2) It is not clear that explicit consent should be sought, or where it is offered honoured, given the potential EV has for deterring organ donors and causing stress to staff and families.
Living organ procurement from the mentally incompetent: The need for more appropriate guidelines
Bioethics, 2012
With the case of Belgium as a negative example, this paper will evaluate the legitimacy of using mentally incompetents as organ sources. The first section examines the underlying moral dilemma that results from the necessity of balancing the principle of respect for persons with the obligation to help people in desperate need. We argue for the rejection of a radical utilitarian approach but also question the appropriateness of a categorical prohibition. Section two aims to strike a fair balance between the competing interests at stake and to define the conditions under which organ harvest from mentally incompetents might be morally acceptable. To this end, we morally assess the main requirements that have been put forward to allow organ removal from incompetent donors. We conclude that the current Belgian legislation is far too permissive and that national regulations that do not permit the harvest of non-regenerable organs from mentally incompetents in exceptional circumstances are too restrictive. On the basis of this discussion, we propose a number of guiding principles for decisionmaking in this area.
In the best interests of the deceased: A possible justification for organ removal without consent?
Theoretical Medicine and Bioethics, 2011
Opt-out systems of postmortem organ procurement are often supposed to be justifiable by presumed consent, but this justification turns out to depend on a mistaken mental state conception of consent. A promising alternative justification appeals to the analogical situation that occurs when an emergency decision has to be made about medical treatment for a patient who is unable to give or withhold his consent. In such cases, the decision should be made in the best interests of the patient. The analogous suggestion to be considered, then, is, if the potential donor has not registered either his willingness or his refusal to donate, the probabilities that he would or would not have preferred the removal of his organs need to be weighed. And in some actual cases the probability of the first alternative may be greater. This article considers whether the analogy to which this argument appeals is cogent, and concludes that there are important differences between the emergency and the organ removal cases, both as regards the nature of the interests involved and the nature of the right not to be treated without one's consent. Rather, if opt-out systems are to be justified, the needs of patients with organ failure and/or the possibility of tacit consent should be considered.
Who shall be allowed to give? Living organ donors and the concept of autonomy
Theoretical medicine and bioethics, 2001
Free and informed consent is generally acknowledged as the legal and ethical basis for living organ donation, but assessments of living donors are not always an easy matter. Sometimes it is necessary to involve psychosomatics or ethics consultation to evaluate a prospective donor to make certain that the requirements for a voluntary and autonomous decision are met. The paper focuses on the conceptual questions underlying this evaluation process. In order to illustrate how different views of autonomy influence the decision if a donor's offer is ethically acceptable, three cases are presented--from Germany, the United States, and India. Each case features a person with questionable decision-making capacity who offered to donate a kidney for a sibling with severe renal insufficiency. Although the normative framework is similar in the three countries, different or sometimes even contrary arguments for and against accepting the offer were brought forward. The subsequent analysis offe...
The National Organ Transplantation Act after Twenty Years: A Time for Reform ?
Organ transplantation has become a proven, cost-effective lifesaving treatment, but its promise is contingent on the number of available organs. The growing gap between the demand and supply results in unnecessary loss or diminished quality of life as well as high costs for surviving patients and their insurers. Twenty years after the enactment of the National Organ Transplantation Act, it is time to rethink the moral basis and overall design of organ transplantation policy. We propose a system of national organ insurance based on a social contract of reciprocal obligation under which aggregated present consent to donate guarantees future availability of organs for those who need them, at least to the level that prevents death while awaiting an organ. The national insurance plan will cover all peri -and post transplantation costs to all. By presuming consent to enroll, we align the default with widespread expectations of reciprocity and mutual self -interest, and surmount barriers to consent that have undermined the spirit of the current legal regime. Individuals who prefer not to be either recipients or donors would be able to opt out of the insurance system.