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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
  1. David Shaw, lecturer in ethics, Faculty of Medicine, University of Glasgow, Glasgow G2 3JZ
  1. davidmartinshaw{at}

It has recently been suggested that patients should be kept alive using elective ventilation to facilitate the harvesting of organs for donation.1 But there is a much simpler way. Veto by the family is the main impediment to an increase in organ donation,2 with at least 10% of families refusing to donate.3 However, the family has no legal grounds for over-riding the dead person’s wishes if that person clearly wanted to donate—for example, by carrying an organ donor card.4

Clinicians who heed the veto are complicit in a family denying its loved one’s last chance to affect the world. Families often regret the veto within two days, and the regret of having denied a loved one’s last wish can last for decades.5 But at the time families are in emotional distress, and clinicians must help them make the correct decision. Clinicians may be willing to respect a veto to avoid distressing families further.2 One solution is a system of so called advance commitment, where donors designate a family member in advance to confirm their decision.2

However, there …

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