Ambiguity Reigns When Organ Donor, Family Wishes Conflict: State Laws vs. Ethics
Frieden, Joyce, Clinical Psychiatry News
Baltimore -- Deciding what to do when an organ donor's family does not want the donation to occur can be a tricky business, several speakers said at a bioethics conference sponsored by the University of Maryland.
"How do we balance how the family feels about what's going on versus what [the donor] wanted? The answer is not clear." said Dr. Gene C. Grochowski of Johns Hopkins University, Baltimore, and chief of nephrology at Franklin Square Hospital. And even if the donor said yes to donation, it's not certain that he or she would have wanted additional stress placed on the family if it's leaning toward saying no, he said at the meeting, also sponsored by Upper Chesapeake Health and the Chesapeake Health Education Program.
Maryland, like many states, has a notation on its driver's licenses indicating whether the driver has agreed to be a donor upon his or her death. Drivers who agree to be donors can simply check yes on the license application or carry a donor card distributed by a private organization.
Of 22 states that maintain a formal donor registry, 13 allow donor designation through the driver's license, according to the Transplant Resource Center of Maryland: Alabama, Delaware, Florida, Georgia, Illinois, Indiana, Maryland, Missouri, Pennsylvania, Tennessee, Utah, Virginia, and West Virginia. But there's really no way to tell how thoughtful a yes such a designation is, said Maryland Assistant Attorney General Jack Schwartz. "It could be a 'soft' yes---just a general sentiment toward being a donor. Or it could be a 'firm' yes, period: 'I want to be a donor and it doesn't matter what my family says.' " Because of this ambiguity, "the driver's license process is not a real model of informed consent," he noted.
States that allow donor designation on driver's licenses vary in how stringently they apply the consent. In Maryland, for example, "the legal answer is utterly clear: yes means yes," Schwartz said. "The yes on the license is termed a 'designation of consent' and is considered sufficient consent for removal of an organ." Permission from the family upon the death of the donor is not required, he said.
The issue of whether to honor a donor's wishes over family objections has been thrust into the limelight now that the United Network for Organ Sharing (UNOS) a group that manages organ procurement and transplants nationwide--seeks to increase the number of organ donations, in part by having states more aggressively enforce donor authorization laws like Maryland's. The House Energy and Commerce Subcommittee on Oversight and Investigations held a hearing in June on ways to increase donations. …