Transplant donor consent and dual roles: A case study in ethical dilemmas

Abstract

• The case addressed an ethical issue that the nurse coordinator faced while withdrawing donor permission. • It demonstrates the risk of coercing donors into donating in order to give the greatest possible medical care. • It examines the ethical aspects of such circumstances from a philosophical and biomedical perspective. This case study describes the ethical dilemma encountered by a Bone Marrow Transplant (BMT) coordinator upon withdrawal of a donor's consent. The case points to the pressure on the coordinator to advocate simultaneously for donor and patient, which results in conflict between the coordinator's dual roles. The aim of this case study is to uncover neglected facts about ethical dilemmas concerning patient donors and transplant coordinators in Saudi Arabian settings. This paper was developed from a case study involving the ethical issues reported here. The paper also explores potential solutions to such dilemmas, especially in centres without FACT-JACIE accreditation. The risk of transplant coordinators’ pressuring potential donors to donate against their will is highly deserving of consideration because it is as dangerous as having the same physician treat patients and assess donors. Societal norms and pressures should be considered, particularly within Saudi Arabian culture, as they may lead to donations made without free and full consent. Health care providers may lose their ethical orientation in this context, especially in unaccredited hospitals or understaffed units. Creating a healthy donor programme is the key to safe practices that preserve donors’ rights, reduce pressure on primary teams and ensure application of international JACIE standards.