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LETTERS: Richard Bartley Is prognosis key in donation? BMJ 2007; 334: 1179-a [Full text]

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Public Transparency or Presumed Consent for organ donation

Mohamed Y Rady, Joseph L. Verheijde, Joan McGregor   (10 June 2007)

Response to Mohamed Y Rady, et al.

Richard Bartley   (12 June 2007)

Public Transparency or Presumed Consent for organ donation 10 June 2007
Mohamed Y Rady, Professor/Consultant Critical Care Medicine Mayo Clinic Hospital, Mayo Clinic Arizona, Arizona, USA, 85054,, Joseph L. Verheijde, Joan McGregor Send response to journal: Re: Public Transparency or Presumed Consent for organ donation	Bartley’s letter illustrates two fundamental errors. First, the argument against presumed consent is not predominantly motivated by theological considerations but rather by medical and scientific rationale. Second, presumed consent violates person’s right for self-determination. Bartley’s letter also illustrates that campaigning for organ donation has been profoundly influenced by misinforming the public about deceased organ procurement(1). While we agree that the prognosis may be a key element for organ donation, the lack of widely accepted criteria for the determination of medical futility among practicing physicians introduces sufficient variability in its application and risks its premature declaration for the purpose of recovering transplantable organs (2). While Bartley contends that death is not always what it seems, especially to relatives, it is undeniable that organ donation transforms “peaceful, respectful” death to a “profanely high tech” death. The deprivation of prospective organ donors of appropriate end-of-life care is a traumatic experience for families and a morally distressing practice for other health care providers (2-4). It is unfortunate that public fear and distrust of the transplant community has to be suppressed by switching to a presumed consent model, abandoning informed voluntary consent and avoiding transparency about deceased organ donation (5). Mohamed Y. Rady, Professor/Consultant, Critical Care Medicine, Department of Critical Care Medicine, Mayo Clinic Hospital, Mayo Clinic Arizona, Phoenix, Arizona, USA Joseph L. Verheijde, Adjunct Professor of Bioethics, Arizona State University, Department of Physical Medicine and Rehabilitation, Mayo Clinic Hospital, Mayo Clinic Arizona, Phoenix, Arizona, USA Joan McGregor, Lincoln Professor of Bioethics, Department of Philosophy, Arizona State University, Professor of Basic Medical Sciences, Director Biomedical Ethics and Medical Humanities, College of Medicine-Phoenix, University of Arizona, Phoenix, Arizona, USA 1. Woien S, Rady MY, Verheijde JL, McGregor J. Organ Procurement Organizations Internet Enrollment for Organ Donation: Abandoning Informed Consent. . BMC Med Ethics 2006;7:14-23 Available at: http://www.biomedcentral.com/1472-6939/7/14. 2. Mandell MS, Zamudio S, Seem D, et al. National evaluation of healthcare provider attitudes toward organ donation after cardiac death. Crit Care Med. 2006;34:2952–2958. 3. Rady MY, Verheijde JL, McGregor J. Organ donation after circulatory death: the forgotten donor. Crit Care. 2006; 10:166-169. Available at: http://ccforum.com/content/10/5/166. 4. Kesselring A, Kainz M, Kiss A. Traumatic Memories of Relatives Regarding Brain Death, Request for Organ Donation and Interactions with Professionals in the ICU. Am J Transplant. 2007;7:211-217. 5. Verheijde JL, Rady MY, McGregor J. Recovery of transplantable organs after cardiac or circulatory death:Transforming the paradigm for the ethics of organ donation. Philos Ethics Humanit Med. . 2007;2:8. Available at: http://www.peh-med.com/content/pdf/1747-5341-2-8.pdf. Competing interests: None declared
Response to Mohamed Y Rady, et al. 12 June 2007
Richard Bartley, Physiotherapist Wales Send response to journal: Re: Response to Mohamed Y Rady, et al.	Organ donation does indeed transform a “peaceful, respectful” death to a “profanely high tech” death. It also transforms very sick people from a “profanely high tech dependency existence” to a relatively “peaceful and respectful life”. There in lies the rub. To argue that presumed consent is in part unethically suspect because of poor public/patient education, seems to miss the point. Address education issues and you have a better chance of making any donor system work better. One of the reasons for public fear and distrust of the transplant community is the failure of the medical profession to agree on the definition of death. If patients had more confidence that robust and transparent systems were in place, backed up by better public education, they may find their loss of self-determination for the benefit of others more palatable. Such a robust system may have prevented the Alder Hay organ scandal, which may have contributed to a rise from 30% relative donor consent refusals in the early 1990s to 42% in 2004 (1). Whilst the choice of the right organ donor system creates an ethical dilemma for society as a whole, I think for the individual this is about confidence in the medical profession. Mandated consent (2) will not necessarily address this. 1. http:// www.parliament.uk/documents/upload/POSTpn231.pdf 2. Verheijde JL, Rady MY, McGregor J. Recovery of transplantable organs after cardiac or circulatory death:Transforming the paradigm for the ethics of organ donation. Philos Ethics Humanit Med. 2007;2:8 Competing interests: None declared