Should potential organ donors be permitted to limit the use of their organs to specific groups or individual patients? A special forum in the June 15 issue of Transplantation, presents expert views on the controversial issue of conditional organ donation.
Transplantation is the official journal of The Transplantation Society and Lippincott Williams & Wilkins, a part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals, and institutions in medicine, nursing, allied health, pharmacy and the pharmaceutical industry.
The forum features summaries of six recent cases illustrating the complex issues involved in conditional organ donation. Invited statements from patient groups, professional organizations, and medical ethicists lend insights into the principles followed in making these difficult ethical decisions. The forum also presents The Transplantation Society's official statement on directed and conditional organ donation.
In the United Kingdom, national debate was stirred by a 1999 case in which the family of a deceased donor stipulated that the organs could be used for transplantation—but only in white recipients. In response, the government and professional organizations issued an "unequivocal" policy against such conditional organ donation: "Organs must not be accepted if conditions about the recipient are attached."
However, new questions were raised when the family of a potential donor agreed to donate only if the deceased man's child—who happened to have a congenital liver disease—received the liver. Although this was clearly contrary to the rule, an exception was made because of the close family relationship between the donor and recipient.
Other scenarios illustrate further dilemmas. For example, one potential donor's family stipulated that the liver could not be used in a patient with alcoholic liver disease. The forum contributors agree that excluding patients with specific causes of disease should not be permitted—since the stipulation on the liver recipient is unacceptable, none of the donor's organs should be accepted.
Meanwhile, the forum also includes an opinion poll showing that a substantial proportion of the British public considers it acceptable to exclude patients with alcoholic liver disease. In contrast, a large majority feel that racial restrictions are unacceptable.
In its official statement, The Transplantation Society outlines its principles and policies on conditional organ donation. The statement excludes donation restricted to members of any "group, class, or organization"—including restrictions by race, religion, or cause of disease. (Another type of "conditional donation"—specifying which organs or tissues will be donated—continues to be permissible.)
The statement also supports the right to "directed donation," but in certain less-common situations. As in the case of the child with liver disease, such donations may be acceptable if the recipient is someone with whom the donor has a "personal or longstanding emotional relationship." For example, the potential donor cannot have learned about the patient on television or the Internet, as occurred in one of the case scenarios.
The Transplantation Society statement and other forum articles do not represent the final word on either conditional donation—even among the groups represented, there are considerable differences in opinion. "Maintaining public confidence in all aspects of managing organs donated for transplantation is essential," write Drs. James Neuberger and David Myer in an introductory statement.
"The variation in opinions expressed and the often discordant views expressed means that open debate is essential so that the often competing demands of justice, equity, benefit and utility are not only balanced but seen to be balanced."