Organ Donation in the US
Organ Donation in the US
Introduction
Organ donation refers to the donation of biological tissues of the human body. The organs can be transferred from a dead person or a living person to a living recipient who needs organ transplant. The organs and tissues used in transplantation are removed using surgical procedures. Physicians conduct the procedures after determining the medical history and social history of the donor. There are several ethical issues associated with organ donation such as consent, allocation of resources among others. Presumed consent, independence and organ donations have become a major issue in US and other countries.
People have varied views concerning presumed consent. The supporters of presumed consent assume that presumed consent will help overcome the shortage of organs in the country. Also, they assume that presumed consent will ensure all individuals have a chance to donate their organs after death even without the consent. Alternatively, the opponents of presumed consent claim that presumed consent will affect the autonomy of the patient. This is because dead people will be forced to donate organs against their will by assuming they wanted to donate thee organs.
Discussion
Presumed consent
Presumed consent was aimed at increasing the supply of organs needed for transplant. The organs supply in United States has decreased greatly because of consent issues. The present American system does not encourage people to donate organs, and this has affected the supply (Gill, 2004). This has affected patient’s health as there are many patients in the country who need organ transplant. The number of patients needing organ transplant in US has increased greatly, but they are unable to get organs (Gill, 2004). Permitting presumed consent will increase the supply of organs as many organs will be obtained from those who die.
Scholars have encouraged the adoption of presumed consent to bridge the gap between organ supply and the need for organs in the United States. Under presumed consent, the country will assume that a person agreed to donate his or her organ after death unless the person or family objected posthumous organ donation. The adoption of presumed consent will change the existing laws governing organ donation. The current laws require patients and other people to give consent before the organ donation (Cohen, 1992).
The opponents and advocates of pre summed consent have identified shortfalls and strengths of the current system of organ donation to support their arguments. The advocates of presumed consent believe that presumed consent would be effective than the current system in respecting the wishes of the citizens. Almost 70% of the citizens prefer to donate their organs for transplantation after death according to Cohen (1992). However, only few organs suitable for donation and transplant are donated. Less than 70% of organs are donated (Cohen, 1992).
Cohen has associated the lower number of organs donated to lack of consent from the patient. Many citizens who want to donate their organs after death do not leave wishes that are clear enough to overcome the challenges of the present system. The present system prevents removal organs without patients consent. As a result, a large number of people who wanted to donate organs after death get buried with their organs. This infringes their wishes about what should happen to their organs and bodies after they die. Implementing a policy of presumed consent would ensure their wishes are respected more than 70% of the time (Cohen, 1992).
Conversely, the opponents of presumed consent claim that presumed consent is not morally acceptable as it infringes a person’s wishes. People have various wishes concerning what should be done with their bodies after death according to Veatch and Pitt. Almost 30% prefer not to give their organs after death (Veatch & Pitt, 1995). The 30% will not have a chance indicate their desire not to donate their organs if pre summed consent is implemented. This will in turn violate their wishes. The current system protects the wishes of the 30% as the physicians cannot remove the organs without the patient’s consent (Veatch & Pitt, 1995).
Therefore, the current system is effective in protecting and respecting the wishes of the patients than presumed consent. The researchers have based their data on a Gallup survey conducted in 1999. The survey determined the perception people have concerning presumed consent. Issues of patent consent an objection from family members made the presumed consent policy in effective. This resulted to abandonment of the policy in various states in 2006. However, policy makers and legislators are pushing for the presumed consent policy in US and other nations. The policy will help overcome the shortage of organs for transplantation (Veatch & Pitt, 1995).
History of presumed consent
The government implemented the presumed consent policy in 1960s to address the shortage of cornea, pituitary glands and other organs for transplantation. The cornea helped restore people’s sight especially infants born with non functioning cornea. In addition, the pituitary glands were a source of growth hormones used in medical treatment. The development of synthetic hormone for growth in 1985 replaced the natural growth hormone. This reduced the risk of transmitting Creutzfeld Jakob disease from the donor to the recipient.
States applied the presumed consent policy only to corners medical examiners. The policy was applied to patients in health care facilities in California. Georgia adopted the cornea retrieval law in 1978. This increased the cornea transplants from 25 to 1000 between 1977 and 1984. Florida developed the cornea statue in 1977 and the organ transplants increased from 500 to 3000 between 1975 and 1984. The cornea transplants in Texas increased from 215 to 1300 after adopting the presumed consent policy in 1977(Orentilcher, 2009).
Other states in the county did not support presumed consent policy and did not experience an increase in cornea transplant like Florida, Texas and Georgia. The states prevented physicians and corners from exercising their presumed consent authority. However, family members objected the presumed consent policy after realizing that physicians removed organs from their family members without permission. The court defended the policy in three cases. The Michigan court defended the policy in 1984 as it did not find a violation of constitutional rights. The Georgia Supreme Court defended the policy in 1985 as it did not find any infringement of constitutional rights. Further, the Florida Supreme Court defended the policy as it did find a violation of constitutional rights. The Supreme Court claimed that the policy benefited the citizens (Orentilcher, 2009).
The drafter of the UAG encouraged the use of presumed consent policy in 1987. However, medical examiners were required to carry out a thorough review of the patient’s medical record and get authority from the family before implementing the policy. As a result, some states included the “reasonable effort” in their presumed consent laws, but others did not. The states encouraged physicians to determine the patient’s medical history and get permission from the family before implementing the law. Some states limited the retrieval of organs to the cornea and pituitary while others did not. By 1990, many states in the United States had passed the presumed consent law and courts supported the law (Gill, 2004).
In 1991, the US court of Appeal expressed concerns regarding getting corneas from cadavers without hearing the family. The court argued that consent is required before retrieving the cornea as family members have limited property rights to the body of the dead person. Various ethical theories present differing arguments concerning presumed consent. According to utilitarianism, the implementation of informed consent makes sense (Orentilcher, 2009).
The advocates of utilitarianism claim that the donation of organs after a person’s death benefits those in need of organ transplantation and improves the quality of their life. On the contrary, the advocates of deontology assume that people do not own their bodies like cars, homes etc. Therefore, bodies should not be sold like homes and cars as they are not property. Thus, people should pass their organs to recipients after getting full benefits from them (Michael, 2004).
The presumed consent failed because of various reasons. First, the policy did not address reasons why citizens do not become donors after death. People do not become donors after death due to objection from family members. The policy should have addressed the resistance of family members to removal of organs to become successful. Second, the policy failed because it violates a person’s autonomy by getting organs without consent. Third, the presumed policy failed because physician did not involve family members in the transplantation process.
The physicians did not get permission from family members before removing the organs. Fourth, the abuse of the presumed consent by physicians led to abandonment of the policy. Many people worried that transplant staff would misuse their presumed consent authority by acting without family and patient consent. Lastly, the increase in rate of crime in the society forced states to abandon the policy. Cases of murder and death increased greatly as criminals got a ready market for the organs (Michael, 2004).
Effect of presumed consent
The presumed consent has an effect on patients, families and the country in general. Legalizing presumed consent will affect autonomy, confidentiality and fidelity of the patient and family. Presumed consent affects the patient’s autonomy and family autonomy (Gill, 2004). The presumed consent system does not encourage the involvement of family members in the transplantation process. Physicians rarely get permission from family members, and hence use their authority to remove the organs.
Excluding the family members from the process increases the risk of health care professionals misusing their presumed consent authority by removing organs. The risk is high in presumed system compared to the current system of actual consent. Actual consent ensures physicians do not misuse their authority as it is closely monitored. Family members are involved in the organ retrieval process as they are they provide the consent. If physicians remove the organs without informing the family members, it would be difficult for members to identify unethical practices (Hayley, 2011).
Additionally, it affects the autonomy of the dead person and the minority. The presumed consent assumes that the person wanted to donate his/ her organs if not indicated. Assuming the person wanted to donate the organ affects the autonomy of the person. The supporters of presumed consent argue that presumed consent protects the wishes of the dead person by removing the organs. However, it violates the decision made by the person in case he did not want his organ removed. This in turn, affects the person’s autonomy to decide whether to donate or not donate. In addition to that, the informed consent affects vulnerable populations and minority. The presumed consent policy will result to erroneous donation than the present actual consent system. The possibility that citizens do not want to donate organs is crucial with minorities.
The poor and minority do not support presumed consent and organ donations. Surveys have shown that organ donation is supported by the majority and wealth. Whites provide consent to organ donation in their driver’s license more compared to Latinos, African Americans and other minorities. Vulnerable population might not support presumed consent and are not aware of the presumed consent policy. Thus, implementing the presumed consent policy will affect the vulnerable and minority in the society. Presumed consent will operate to the disadvantage of the vulnerable population if they do not have a method to opt out of the policy (Committee on increasing rates of organ donation, 2006).
Confidentiality and fidelity play vital roles in organ donation. Physicians and other health care professions are supposed to keep their promises and be faithful when providing care to patients. They should keep the promises outlined in the patient’s consent for organ donation. Physicians can keep the promises by respecting the decision made by the patient. Some patients prefer to donate organs after death and others not. Presumed consent violates the promises made by professionals to patients by assuming all patients needed to donate organs after death. This affects patients who had decided not to donate their organs by changing their wishes.
Lastly, confidentially is crucial in organ donation as donors and recipients should be confidential. Professionals should not disclose any information about the donor or recipient with their consent as this violates their confidentiality. The donor can share information with the recipient. The information about the donor or recipient is disclosed if required to protect one of them or the public (Alberto & Sebastian, 2006).
Current resources to address the issue
There are various resources that needed to address the issue of presumed consent and promote informed consent system. The government needs to invest heavily to resolve the issue of organ donation. It needs financial resources and education resources to address the problem. The government should allocate resources to prevent presumed consent and encourage informed consent. It should ensure citizens have donor cards to make informed decisions about organ donation. The government should support the informed consent by educating the public about its benefits as opposed to presumed consent. The educational materials can be provided to the public through websites and other media. There are no sufficient resources to solve the problem and hence this has affected the implementation of informed consent system fully (Alberto & Sebastian, 2006).
Alternatives to presumed consent
Though presumed consent increases the supply of organs donated in United States and other countries, it has causes more harm to the donor, family and the country. It leads to misuse of presumed authority by doctors and affects patient autonomy. Hence, the presumed consent should be replaced by informed consent. The informed consent might not be effective in increasing the supply of organs and overcoming organ shortage, but it protects the patients. The informed consent or actual consent system protects the patient and family members from exploitation by the professionals.
The patients give consent to remove their organs after death and this protects their autonomy. Also, family members give consent where the patient is not, able. The family is involved in the organ donation process and hence prevents unethical practices among physicians. Informed consent system promotes the duty of fidelity as professionals fulfill their promises to the patient during organ donation. They respect the wishes of patients. Informed consent also reduces crime rate by reducing murder cases due to lack of market for organs. Thus, the government should support the informed consent system instead of presumed system so as to benefit the donor and receiver (Taylor, 2012).
Conclusion
In conclusion, the shortage of organs in the United States and other countries has forced the governments to look for alternative ways to increase the supply. The presumed consent system has been considered effective in increasing organ supply in various countries. United States implemented the presumed consent in 1960 to increase cornea and pituitary gland donation. Several states adopted the policy and this increased transplantations. Violation of autonomy and fidelity has affected the presumed consent policy. People object the presumed consent policy as it affects the patient’s autonomy or donor’s autonomy to make organ donation decision.
The policy does not respect the patient’s decision not to donate organs, but assumes those who have not indicated whether they want to donate organs or not want to. Thus, doctors violate the duty of fidelity as they do not keep their promises. They also affect the patient’s wish. The supreme consent should be replaced by informed consent to protect patent’s autonomy and involve the family in organ donation process. It will also support duty of fidelity and confidentiality.
Reference
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