Published 2 November 2009, doi:10.1136/bmj.b4511
Cite this as: BMJ 2009;339:b4511

Letters

Organ donation

Informed choice, not coercion

The first 150 words of the full text of this article appear below.

The ACRE trial found that collaborative requesting did not significantly increase consent rates for organ donation, and the authors discussed whether structured training for donor transplant coordinators might make it more effective.¹ They cited a recent BMJ editorial by Teresa Shafer on such a structured training programme.²

At that point, conflicting ethical obligations arise—the phrase "structured training" masks the real nature of the strategy recommended by Teresa Shafer, that "successful requestors act as advocates for people on the organ transplant waiting list" and "are presumptive, not neutral." Unlike collaborative requesting, the "presumptive approach" is far from widely accepted.³ The presumptive approach has been accused of undermining the ethics of informed consent.⁴

Organ donation and transplantation save lives, but we have to consider the ethics of different strategies for filling the gap between the number of organs needed and the number of organs donated. Donor transplant coordinators should not be dual . . . [Full text of this article]

¹ Department of General Practice, University of Göttingen, Humboldtallee 38, D-37073 Göttingen, Germany

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