Intended for healthcare professionals

Rapid response to:

Views & Reviews Personal View

We should not let families stop organ donation from their dead relatives

BMJ 2012; 345 doi: (Published 07 August 2012) Cite this as: BMJ 2012;345:e5275

Rapid Response:

Re: We should not let families stop organ donation from their dead relatives

Do not Forget the Moral Responsibilities of Organ Donors

Few, if any, of our projects could be accomplished without the support and assistance of others. Donating an organ is no different. If an individuals projects includes becoming an organ donor in a particular set of circumstances which, arguably, is a project we should all adopt then we must bear in mind that we cannot accomplish this alone. At minimum we should notify the State and the medical profession of our intentions via the Organ Donor Register (ODR) and, I would argue, we should also inform and discuss such decisions with our families. In the first instance it is simply a practical matter that registering with the ODR is the primary mechanism for achieving our ends and we might think similarly regarding discussing the matter with our families. However discussing the matter with our families is not only a practical requirement but is also an ethical or moral imperative. In her eloquent essay Hilde Lindmann has demonstrated that the moral aspects of dying extend beyond the biological and that if they are to be enacted our views on ‘dying well’ will require the support of both our families and healthcare professionals. If, in certain circumstances, our idea of dying well includes becoming an organ donor it is our responsibility to discuss our views with those who may be in a position to influence the kinds of death we die.

Dr Shaw’s proposal that medical professionals ignore any family objections to organ donations fails to recognise that our projects cannot be accomplished without the support of others. Or, more accurately, his recognition of this fact remains implicit and extends only to medical professionals. As a result all of the moral responsibility for enacting the wishes of organ donors is placed squarely on the already morally burdened shoulders of such professionals. We should recognise that families have legitimate moral duties towards each other and that this may include facilitating the organ donation of a deceased member. However this cannot be the case if the potential organ donor has not discussed the matter with them. Our decisions to donate organs in the eventuality of our deaths may well have consequences for our families and will require their support. However, at the same time, it would be wrong to simply register our views about organ donation with our families in a manner akin to inform the ODR. Those amongst us who wish to be organ donors should, ethically should, discuss the matter with our families, solicit their support and, perhaps encourage them to register with the ODR too. This view differs from, but is not overly dissimilar to, that of De Wispelaere and Stirton as set out in an article Dr Shaw cites.[2]

The family veto is not and should not be inscribed in law but this cannot be taken to mean that their views are of no moral relevance or that the spirit of the law is that family objections to organ donation should be ignored. It should not, as Dr Shaw seems to suggest, be taken as a license for Doctors to ignore the wishes of a deceased person’s family. I am registered with the ODR because I believe that the UK approach to organ donation is an ethical one. If organ harvesting began to take place in the face of familial objections I, as I am sure many others, would reconsider their inclusion on the ODR. Many people who would be willing to become organ donors in the eventuality of their deaths fail to register with the ODR and, I am sure, may of those (register and unregistered) do not clearly and openly discuss the matter with their family. If there is a failure in our moral imaginations (and actions) it is in regard this and not, as Dr Shaw suggests, in regards harvesting the organs of those registered with the ODR by fiat and against the express wishes of bereaved family members. If our aim is to increase the supply of donated organs and to do so ethically it is this that we should concentrate on.

Respecting a family’s veto of organ donation is neither unethical, unprofessional nor against the spirit of the law. We should recall that it is the potential organ donor’s responsibility to ensure their family know, and support, their wish to donate their organs in the eventuality of their death. Doctors cannot and should not absolve patients of their ethical and moral responsibilities nor should they compound our failure to fulfil them by seeking to harvest the organs of deceased patients against the wishes of bereaved family members.

[1] Lindemann, H. “Holding on to Edmund: The Relational Work of Identity.” In Lindmann, H. Verkerk, M. & Urban Walker, M (Eds). Naturalized Bioethics: Toward Responsible Knowing and Practice. Cambridge University Press. 2009: 65–79.

[2] De Wispelaere J, Stirton L. Advance commitment: an alternative approach to the family veto problem in organ procurement. J Med Ethics 2010;36:180-3.

Competing interests: No competing interests

10 August 2012
Nathan Emmerich
Queen's University Belfast
School of Sociology, Social Policy and Social Work