Organ donation and transplantation

Abstract

An ethical organ donation and transplantation program regarding deceased patients donors would balance the needs of the organ recipient with the needs of the organ donor and his or her family. The solution to achieve ethical balance is not easy. The donation community leans toward Kantian ethics to justify actions on the donor, while the transplant community tends toward utilitarian justifications that focus on recipient outcomes. Yet the responsibility to achieve balance lies with both communities (and their wider healthcare colleagues) to work together so that good end-of-life care for donors is achieved while simultaneously increasing the number and quality of deceased organ transplants. This chapter will use our personal knowledge of the British and Spanish organ donation and transplantation systems to ask if organ transplantation fosters or threatens end-of-life care in critical care and emergency medicine. Our conclusion is that by adopting a rule utilitarianism approach, ethical balance is more likely to be achieved. We propose three rules for any donation and transplantation program: (1) The exploration of organ donation for all patients dying in critical care and emergency medicine should be pursued, as organ donation might improve end-of-life care and can honor the ideal of a “good death”; (2) Organ donation must never compromise a “good death”; and (3) All parties should seek to build institutional trustworthiness.