The ethics of organ donation and transplantation: Long-established, regularly re-examined

The Donor Research Network's (DoRN) Symposium Series presents Thomas Mone.
Abstract: The ethics of organ donation were vigorously researched, debated, and formalized as the field emerged in the latter half of the Twentieth Century. This work concluded that the recovery and transplantation of deceased donor organs was ethical when organs were voluntarily donated and allocated in a manner that served the patients who had waited the longest, maximized the number of lives saved through transplantation, while recognizing the logistical and biological constraints of organ viability once recovered. With the advent and promulgation of brain death testing, the reliance upon Donation After Circulatory Death (DCDD) that was common in the earliest days of donation became relatively uncommon, and Brain Death (BD) became the standard of the field. The reemergence of DCDD in the early 2000s brought the ethical issues that had previously been resolved back to the forefront of discussion, not so much with Transplant and Donation professional, but with Donor Intensive Care and Palliative Care practitioners. Simultaneously, the ethics of organ allocation have reemerged as the ability to successfully share organ more broadly has been demonstrated and the ability to identify recipients who will likely benefit from the most years of graft function has prompted reevaluation the ethics of the prioritization of graft life, waiting time, age, and time from organ recovery to transplant. Additionally, the field regularly is called on by routinely well-meaning but underinformed individuals to address questions of the ethics of Organ Donor Registries and of Presumed Consent practices; topics whose ethical issues have long been decided, but not necessarily well promulgated. Finally, most recently, in the US fundamental question of when and how death is declared have been re-raised by small special interest groups with long-standing concerns about the removal of life-sustaining ventilation how death is declared. These continuing debates warrant a discussion with a mind to sharing the history of substantive debate and conclusions re the ethical underpinnings of organ donation and transplantation.

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