Consolidate the donor register with unambiguous affirmation from next of kin

Shaw argues that we should not let families stop organ donation from their dead relatives.1 He seems never to have considered the practicalities of taking a brainstem dead ventilated patient to the operating theatre without the cooperation of the next of kin, or the practicalities of expecting the family to agree with an arbitrary time frame for removal of active support if donation after cardiac death is being planned, and with initiation of retrieval procedure after the five minute interval for confirmation of death after loss of cardiac output.

For Shaw to believe that he can prescribe a sustainable strategy with medical compliance and societal support, with no risk of tangible antipathy to the broader transplantation programme, seems exceptionally naive. He ignores the fact that most requests by doctors occur when the patient’s wishes were not formalised on the donor register, and when medical staff have established trust in their care and in their declarations of futility before—at a time of overwhelming distress—sensitively broaching the subject of potential benefit to others through donation. To suggest that these practitioners lack “moral imagination” and engage in unethical, unprofessional, and unlawful conduct is unfair and inflammatory.

Shaw is worryingly misguided when he declares, “There is a simpler solution: get doctors to do their jobs.” The most ethically acceptable and efficacious strategy in these circumstances is to ensure that everyone who expresses a wish to donate on the register consolidates this wish with positive, unambiguous affirmation from their next of kin.