Presumed Consent and Organ Constriction
Considering the scarcity of organs in the healthcare system, constriction of the cadaveric organs has been viewed as an alternative; however, there are numerous arguments against this idea regarding the moral ethics to acquire the organs without the prior consent of the deceased. The presumed consent adopted by some states can be regarded as morally and ethically unsound since it deprives the donors and their families to make decisions on their own. Proponents of the idea of presumed consent have however argued that the strategy seeks to considerably increase the supply of organs in the healthcare system to be used in case a situation arises, nonetheless, it is still to put into consideration the individual rights of the organ donors before obtaining them; this has in some way rendered the idea unethical. This is because consent to donate should be a personal choice and not a coercive one.
Saab et al. (2019) have further given the indications that the presumed consent should not be objected because it precludes the personal choice of the deceased but rather a decision should be arrived at after examining the underlying circumstances. For example, it can be considered as morally and ethically right to constrict organs if the donor’s family members or a next of kin is not available despite having made necessary communication to reach them. An example can be given using the laws in Texas which do not necessarily require the consent of the living kin in case the deceased had a prior indication to donate; in such a situation, the presumed consent applies is considered morally right. Considering the painful moments a family undergoes at the point of death of their beloved, asking for their consent or rather the consent of the dying person can be considered inhuman and cruel not to mention the additional grief it would add.
Some states such as Texas have compelling laws requiring citizens to register their opinions regarding organ donation and in situations when this is not done the presumption of approval is carried on which I believe is right considering their previous responsibility to have registered their personal opinions. Some critics of the presumed consent have argued that it is usually right to assume one’s approval since it may be against his /her religious faith to donate. (Kittur et al. 1991)
I believe the policy is fair as claimed by the supporters; this is because as humans out love and the subsequent care for one another, we should freely donate our organs. In circumstances where no formal decision to donate has been made during one’s lifetime, I strongly believe the policy applies since saving a human life is more important and is considered as a charitable act to the society even though the deceased isn’t aware of the actions. In addition to this, further considering the society’s abilities to cope with the rising medical costs and the subsequent rise in deaths of those in need of organs, the presumed consent applies to help solve the impasse.
In circumstances when the donor’s consent for donation is absent, especially in accidents that often lead to serious brain injuries leading to brain deaths, standard guidelines are followed to have the vital and important organs removed from the body. Some researchers have however claimed that the absence of donor consent allows physicians to remove the organs in case of brain death which they consider as morally right and acceptable; however, critics have opposed such arguments with claims such as brain death is not absolute death and that if the patients have not consented to the removal of the organs before their deaths, then it is considered as morally wrong and contrary to the nature of medical practice.
In case a patient had failed to indicate his consent to donate, the relatives may refuse to consent to donation even if they know that the deceased was willing to donate, but the lack of either verbal or written consent gives them the option to object. Healthcare professionals have the responsibility to address the informational needs of the family members and provide better support to the patient if they intend to make donation requests; this is usually done in circumstances when the donor may have not left any indication of consent before his death.
Finally, I suggest that in circumstances where there are no indications of consents to donate, there should be legal and philosophical guidelines that need to be followed by medical practitioners who intend to carry out constriction of organs without consent. I believe there should be rules against the constriction of organs due to brain deaths since this kind of constriction is usually viewed as killing of the patients rather than allowing the patients to die natural deaths. This is because such situations do not warrant constriction unless the donor together with the family, has expressed clear intentions for withdrawal from life support against the presumption idea that it is a natural thing to do for the benefit of the donor and the thousands of the recipients who may require the organ.
Munson, (2014) has proposed alternatives to organ constriction on basis of presumed consent; some of the alternatives have included the option of allowing donors to sell their organs however this option has been highly criticized because sale of human organs could be viewed as dehumanizing humans and the regard of their organs as mere trade commodities. The best alternative brought out by Munson with a view of increasing the availability of donors that has proven to work well in some countries is the attachment of incentives on the donation of organs by either directly paying the donors before their demise or paying off their families.
Other incentives such as tax relief, employment opportunities and even training can be given to persons who indicate their will to donate their organs after their deaths. (Wu & Fang 2013)
Financial incentives such as the compensation of donor expenses have been valued as a better alternative to increase the turnout of those willing to donate or the subsequent approval of constriction by family members. In Iran, donors willing to donate their kidneys are usually rewarded with a sum of 1200 US dollars and a government-sponsored medical cover. This has considerably increased the number of donors to successfully reduce kidney transplant waitlist. (Haghighi & Ghahramani, 2006)
The gap between the organs demanded by ailing patients and the subsequent supply of the same has continued to increase always. It is therefore to review the ethical and moral obligations concerning donating organs to conform to the humane duty of benefitting humanity and the society’s well being. Lavee (2013) suggests that sound ethical amendments should be done to the laws that govern organ transplants to allow for constriction as a legal measure.
Haghighi, A. N., & Ghahramani, N. (2006). Living unrelated kidney donor transplantation in Iran. Nature Reviews Nephrology, 2(12), E1.
Kittur, D. S., Hogan, M. M., Thukral, V. K., McGaw, L. J., & Alexander, J. W. (1991). Incentives for organ donation?. Lancet, 338(8780), 1441-1443.
Lavee, J. (2013). Ethical amendments to the Israeli organ transplant law. Am J Transplant, 13(6), 1614.
Munson, C., & Borcherdt, B. (2014). Fundamentals of Cognitive-behavior Therapy: From Both Sides of the Desk. Routledge.
Saab, S., Saggi, S. S., Akbar, M., & Choi, G. (2019). Presumed consent: a potential tool for countries experiencing an organ donation crisis. Digestive diseases and sciences, 64(5), 1346-1355.
Wu, X., & Fang, Q. (2013). Financial compensation for deceased organ donation in China. Journal of medical ethics, 39(6), 378-379.
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