Ethicolegal aspects of organ donation

Abstract

Deceased organ donation is frequently considered to lie at the interface between a critical care clinician’s primary and non-negotiable obligations to the care of a dying or dead patient and a broader and less well-defined responsibility towards society’s need for suitable donor organs for transplantation. This transition can generate conflicts, real or apparent, which in turn become barriers to interventions that might otherwise promote deceased donation. In its 2008 report Organs for Transplants, the UK Organ Donation Taskforce, mindful of these obstacles, recognized an urgent need ‘to resolve outstanding legal, ethical and professional issues in order to ensure that all clinicians are supported and able to work within a clear and unambiguous framework of good practice’. Since the publication of the Taskforce report, much has been done to assemble such a framework. For instance, professional bodies have produced ‘consensus’ statements on donation after circulatory death (DCD) and the care of potential donors identified in emergency departments. In addition, relevant governmental agencies have provided legal guidance on DCD, while the UK Donation Ethics Committee (UK DEC) has begun to consider a range of issues relating to deceased donation, organ allocation, and transplantation, including DCD. None of these recent developments and publications has been dependent upon new primary legislation or radical shifts in the ethical landscape of critical care practice. Rather, they are the product of focused collaboration between clinical, ethical, and legal experts working with contemporary interpretations of existing UK professional, ethical, and legal standards. What has thereby emerged is a framework of practice that both protects and empowers clinicians to more effectively satisfy the legitimate wishes of an individual to donate their organs after death.