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Supporting Controlled Non-Heart-Beating Donation

An Ethical Justification

Published online by Cambridge University Press:  04 December 2012

DAVID PRICE  and
JO SAMANTA
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Abstract

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Type
Special Section: Consent and Organ Donation
Information
Cambridge Quarterly of Healthcare Ethics , Volume 22 , Issue 1 , January 2013 , pp. 22 - 32
Copyright
Copyright © Cambridge University Press 2012

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References

Notes

1. Gardiner, D, Sparrow, R. Not dead yet: Controlled non-heart-beating organ donation, consent, and the dead donor rule. Cambridge Quarterly of Healthcare Ethics 2010;19:17–26Google Scholar. We prefer the terminology of “non-heart-beating donation,” but “donation following circulatory death” is now becoming the more common usage.

2. This figure comprises 336 out of a total of 959 deceased donors in 2009–2010, a 17 percent increase over the previous year; see National Health Service (NHS) blood and transplant statistics at http://www.organdonation.nhs.uk (last accessed 4 Apr 2011). Results from kidneys have been shown to compare favorably with those of transplants using heart-beating donors; see Summers, DM, Johnson, RJ, Allen, J, Fuggle, SV, Collett, D, Watson, CJ, et al. . Analysis of factors that affect outcome after transplantation of kidneys donated after cardiac death in the UK: A cohort study. The Lancet 2010;376(9749):1303–11Google Scholar.

3. There was a 9 percent reduction in the number of heart-beating donors between 2001 and 2008, although there was a slight (2%) upturn in the period 2009–2010 as compared to the previous 12-month period.

4. See note 1, Gardiner, Sparrow 2010, at 17.

5. See note 1, Gardiner, Sparrow 2010, at 20.

6. See Price, D. End-of-life treatment of potential organ donors: Paradigm shifts in intensive and emergency care. Medical Law Review 2011;19(1):86–116.Google Scholar

7. See note 1, Gardiner, Sparrow 2010, at 17.

8. Youngner, SJ, Arnold, RM. Ethical, psychological and public policy implications of procuring organs from non-heart-beating cadaver donors. JAMA 1993;269(21):2769–74CrossRefGoogle Scholar. In fact, these authors are intending to extend the DDR only to those situations in which organs are actually removed prior to death, even if this does not result in the death of the patient.

9. Perspective roundtable on organ donation after cardiac death. New England Journal of Medicine; available at http://www.nejm.org/doi/suppl/10.1056/NEJMp0804161/suppl_file/nejmp0804161_transcript.pdf (last accessed 4 Apr 2011).

10. See note 1, Gardiner, Sparrow 2010, at 20. Do they mean solely as a means?

11. Kant, I. Grounding for the Metaphysics of Morals. On a Supposed Right to Lie Because of Philanthropic Concerns. 3rd ed.Ellington , JW, trans. Indianapolis: Hackett; 1993Google Scholar [1785], at 30.

12. King’s Fund Institute report, a question of give and take: Improving the supply of donor organs for transplantation. London: King’s Fund Institute; 1994. Research Report 18.

13. Feinberg, J. Harm to Others. Oxford: Oxford University Press; 1985.Google Scholar

14. See Schulman A. Staff Working Paper, Bioethics and Human Dignity, President’s Council for Bioethics; 2005; available at http://bioethics.georgetown.edu/pcbe/background/human_dignity.html (last accessed 4 Apr 2011). Moreover, seeking to further the prior intentions of would-be donors would seem to promote their previous self-determined choice and to serve dignity as empowerment rather than dignity as constraint. See Beyleveld, D, Brownsword, R. Human Dignity in Bioethics and Biolaw. Oxford: Oxford University Press; 2001.Google Scholar

15. There is in any event doubt as to the extent to which the Kantian concept of dignity is applicable to permanently insensate individuals insofar as this notion is grounded in respect for those who possess rational will and autonomy, being the basis for moral status.

16. General Medical Council (GMC). Treatment and Care Towards the End of Life: Good Practice in Decision Making. GMC; 2010Google Scholar; available at http://www.gmc-uk.org/End_of_life.pdf_32486688.pdf (last accessed 25 Aug 2012).

17. Dworkin, R. Life’s Dominion. New York: Alfred A. Knopf; 1993.Google Scholar

18. Coggon, J, Murphy, P. Ante-mortem issues affecting deceased donation: An ethico-legal perspective. In: Farrell, A-M, Price, D, Quigley, M, eds. Organ Shortage: Ethics, Law and Pragmatism. Cambridge: Cambridge University Press; 2011:136–48.Google Scholar

19. Dame Butler-Sloss LJ in In re A (Medical Treatment: Male Sterilisation) [2000] 1 FCR 193, at 200.

20. Re Y (Mental Patient: Bone Marrow Donation) [1997] 2 WLR 556.

21. Ahsan v. University Hospitals of Leicester NHS Trust [2007] P.I.Q.R. P19.

22. See note 16, GMC 2010.

23. Rajczi, A. Making risk-benefit assessments of medical research protocols. Journal of Law, Medicine and Ethics 2004;32:338–48.CrossRefGoogle ScholarPubMed

24. See note 16, GMC 2010.

25. United Kingdom Donation Ethics Committee (UKDEC). An Ethical Framework for Controlled Donation after Circulatory Death. Academy of Medical Royal Colleges; 2011 Dec; available at http://www.aomrc.org.uk/publications/statements/doc_view/9322-an-ethical-framework-for-controlled-donation-after-circulatory-death.html (last accessed 25 Aug 2012).

26. Mann, T. The Magic Mountain. Woods, JE, trans. Everyman’s Library. New York: Random House; 2005Google Scholar [1924].

27. See note 25, UKDEC 2011, at para. 13.

28. Feinberg, J. Harm to Others. Oxford: Oxford University Press; 1985.Google Scholar

29. Browne, A, Gillett, G, Tweedale, M. Elective ventilation: Reply to Kluge. Bioethics 2000;4(3):248–253CrossRefGoogle Scholar, at 251.

30. Browne, A, Gillett, G, Tweedale, M. The ethics of elective ventilation. Bioethics 2000;14(1):42–57CrossRefGoogle Scholar, at 54.

31. See note 1, Gardiner, Sparrow 2010, at 22.

32. Department of Health NSW. Organ Donation After Cardiac Death: New South Wales Guidelines; 2007, at 6; available at http://www.health.nsw.gov.au/archive/policies/g1/2007/pdf/GL2007_012.pdf (last accessed 25 Aug 2012).

33. Department of Health. Legal Issues Relevant to Non-Heart-Beating Organ Donation; 2009, at para. 6.12; available at http://www.ics.ac.uk/intensive_care_professional/legal_issues (last accessed 25 Aug 2012).

34. The UK Donation Ethics Committee recommends carrying out research to ascertain the potential of the Organ Donor Register to include patients’ views about interventions during the dying moments to support donation, research, and related issues. See note 25, UKDEC 2011, recommendation 31 at 55.

35. See note 29, Browne et al. 2000, at 53.

36. See note 1, Gardiner, Sparrow 2010, at 22.

37. See note 1, Gardiner, Sparrow 2010, at 22.

38. Well-being. Stanford Encyclopedia of Philosophy; available at http://plato.stanford.edu/entries/well-being (last accessed 25 Aug 2012).

39. Although a discussion on futility lies outside the remit of this response, it is relevant in that the fundamental aims of patient care will shift in focus once it is determined that further life-sustaining treatment is no longer in the medical interests of a patient.

40. See, for example, Re Y (Mental Patient: Bone Marrow Donation) [1997] 2 WLR 556.

41. Pellegrino ED. The President‘s Council of Bioethics. Session 2: Living organ donation: Outcomes and ethics; dicussion of staff working paper by Ginger Gruters 2006; available at http://biothics.georgetown.edu/pcbe/transcripts/sept06/session2.html (last accessed 25 Aug 2012).

42. Kovács, J. The transformation of (bio)ethics expertise in a world of ethical pluralism. Journal of Medical Ethics 2010;36:767–70.Google Scholar

43. Miola, J. Medical Ethics and Medical Law. A Symbiotic Relationship. Oxford: Hart; 2007, at 54Google Scholar.