The Difficult Ethics of Organ Donations From Living Donors Who Cannot Give Direct Consent

A recent Wall Street Journal article discussed the issue of family consent for kidney donations from patients who lack decision making capacity (June 26, 2016).  For example,  a woman wanted to donate the kidney of her dying husband prior to withdrawing life-sustaining treatments that would lead to his death.  Donation after death was not possible, as it was thought that after withdrawal of life-sustains treatments, the patient’s heart would continue to function for more than an hour.  According, by the time he died, doctors believed, his organs would no longer be viable for transplantation. The family proposed that the patient serve as a living organ donor—even though, unlike a typical living donor, he couldn’t directly articulate the decision.  Although the hospital’s ethics committee gave approval for the donation, no surgeon would do the procedure, as it was thought it was not ethical to harvest the kidney with the patient’s direct authorization.

Writing in a “letter to the editorial” (July 1, 2016). Dr. Henry Silverman, who chairs the ethics committee at the University of Maryland Medical Center,  writes that while it appears that there is  “moral distress” being voiced by the surgeons and the United Network for Organ Sharing regarding the lack of direct authorization  for donation from patients, but no such moral discomfort exists regarding the removal of life supports from the same patients, leading to their certain deaths without their direct authorization. Dr. Silverman asks, ‘What accounts for the lack of moral equivalency between accepting surrogate consent to allow patients to die but not allowing surrogate consent for living donations from the same patients?”

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