FROM THE EXPERTS

From the experts: Organ donation

PUBLISHED : Tuesday, 21 August, 2012, 12:00am
UPDATED : Tuesday, 21 August, 2012, 10:36am

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The British Medical Association has recently suggested that patients should be kept alive using elective ventilation, or life support, to facilitate the harvesting of their organs for donation.

But this is useless if the patient's family vetoes his or her wish to donate. In fact, this problem is the main hindrance to organ donation, with at least 10 per cent of families in Britain refusing permission.

There is of course a much simpler way to solve this problem: getting doctors to do their jobs.

Doctors who heed the family's veto deny the patient's last wish to help the world. The family has no legal grounds to override the deceased's wishes if that person clearly wanted to donate, such as by carrying an organ donor card.

It is true that the situation causes families emotional distress, and doctors may be willing to respect a veto to avoid upsetting them further. One solution is so-called advance commitment, where donors designate a family member in advance to confirm their decision when the right time comes.

The failure to overrule the veto and to respect the wishes of the deceased is a classic case of doctors giving in to psychological pressure without considering the wider effects on others.

The doctor causes deaths by omission and greater distress to other families whose relatives will die because they failed to get an organ transplant. When a doctor encounters resistance from a patient's family, he can either leave them alone or persist in ensuring the organ donation.

Persistence will cause the family short-term distress, but they usually see within a week that the doctor was right. And of course they have no legal grounds to complain.

If the doctor does not persist, the family will be relatively happy in the short term but will probably regret their decision. Further, the patient's eyes, heart, kidneys and other organs will have gone to waste, with grave consequences for other patients in need.

Giving in to the family is unprofessional. Although we should treat the family compassionately, doctors have a duty to dying patients and organ beneficiaries.

Kenyon Mason and Graeme Laurie, authors of the 2006 book
Law and Medical Ethics, state that "while this may be laudable sympathetic medicine, it is paradoxically doubtful medical ethics".

Many family members who oppose their loved one's organ donation even come to regret their decision days or weeks later.

Moving towards elective ventilation might alienate would-be donors and will not be necessary if doctors remember that respecting a veto of organ donation is unethical, unprofessional and against the spirit of the law.

David Shaw is a lecturer in ethics at the University of Glasgow's faculty of medicine. He can be reached at davidmartinshaw@gmail.com. This column was first published in this month's
British Medical Journal