Chapter 16 : Allocation of Resources: Scarcity and Triage

Case Title: Presumed consent of organ removal by Gleny S. Fernandez Lopez. –

The Presumed Consent Subcommittee of the UNOS Ethics Committee was charged with evaluating the ethics of presumed consent as a legal-policy regime for the regulation of the donation of cadaveric organs and tissues for transplantation. The contemporaneity of the discussion is evidenced by the recent introduction of bills based on presumed consent into the Maryland and Pennsylvania state legislatures. In this paper we as a Subcommittee evaluate presumed consent from an ethical perspective and propose an alternative organ donation reform called "required response." What this means is: “Public policy based on presumed consent would offer every adult the opportunity to express and have recorded by publicly accountable authorities his or her refusal to be a donor of solid organs and tissues. A clinically and legally indicated candidate for cadaveric organ and tissue recovery is presumed to have consented to organ and tissue recovery if he or she had not registered a refusal”. In the above definition of presumed consent, there is no allowance for the donor's family to interfere with the donation process. This is the strong version of presumed consent. In the state initiatives in Pennsylvania and Maryland, a variant of the weak version is being considered. A weak version of presumed consent requires the permission of the donor's family, if the family can be located, before organs and tissues are removed.

Article with more details about organ presumed consent 

https://optn.transplant.hrsa.gov/resources/ethics/an-evaluation-of-the-ethics-of-presumed-consent/

This article expands on the details about organ presumed consent and what really matters

 https://www.thehastingscenter.org/briefingbook/assisted-reproduction/

This article presents the family over rule in organ presumed consent

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5606427/

 This article talks about organ presumed consent not being an answer to organ shortage in USA

https://www.hopkinsmedicine.org/news/media/releases/presumed_consent_not_answer_to_solving_organ_shortage_in_us_researchers_say 

Ethical analysis:

This article talks about the ethical and legal issues in organ presume consent 

http://medind.nic.in/jal/t14/i4/jalt14i4p404.pdf

This article expands more on the issues that arise within organ presumed consent 

https://onlinelibrary.wiley.com/doi/full/10.1111/ajt.14402

 This article talks about the ethic differences in presumed and expressed consent

http://virtualmentor.ama-assn.org/2005/09/pfor2-0509.html

 This article talks about the ethical issues in presumed consent

https://www.nature.com/news/presumed-consent-1.13316

Proceed to the DECISION SCENARIO section of the chapter by clicking here> section.

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