Two fundamental ethical and legal rules for deceased organ donation

Abstract

Learning objectives By reading this article, you should be able to: • Discuss the two main legal and ethical rules upon which deceased organ donation is based: the dead donor rule and the consenting donor rule. • Describe the legalities of consent for organ donation, including opt-out and deemed consent legislation. • Explain the limits of consent and why there is a need for professional and ethical practice guidance. Key points • Deceased organ donation is built upon two ethical and legal rules: the dead donor and consenting donor rules. • The dead donor rule is standardly formulated as the rule that ‘donors must be determined to be dead before their organs are recovered’. • Worldwide, there are different legislative models for the consenting donor rule: opt-in, opt-out, hybrid and soft or hard enforcement. • Consent to donation may legally permit donation, but it does not mandate that donation occurs or dictate what clinicians should do in a particular circumstance. Clinicians' actions should be guided by professional standards, operating within the boundaries set by law, and based on science, ethics and cultural expectations.