Friday, June 4, 2010

Organ Donation and Advance Care Planning: The Right Mix?

Tarris Rosell, PhD
June 4, 2010

What is interesting to me about what Mark Fox writes is his apparent recommendation of primary care physicians serving as advocates for potential living donor patients.

Currently, that prospective patient-donor enters the transplant program for evaluation as a living donor and becomes a patient there. And as good as most of those clinicians are (in my limited experience anyway), with attentiveness to the principles of respect for person’s autonomy and nonmaleficence, there is nonetheless an inevitable and inherent bias built into the evaluation process.

The bias, of course, is toward donation.

Donation is seen as “the right thing to do.” It is viewed by transplanters as a societal good—good for the organ recipient, and good for the transplant program. With recognition of that conflict of interest, Vanderbilt’s transplant center built in to their process years ago the option, not requisite usually, of an ethics consult interview with the prospective donor and the recipient. (I was one of the ethics consultants during a two year fellowship in the late 1990s. Mark Fox did his clinical ethics training there, as well.)

I believe the transplant ethics consultation service and fellowship has gone away now at Vanderbilt, and is surely not the norm most other places. So prospective living donors probably could benefit from someone outside the evaluating transplant program, perhaps their primary care physician, who helps them assess the risks and harms while balancing those against the potential for benefiting another.

If so, primary care docs will need to be educated on what living donor transplantation entails, since they may have biases, also, and those might not be well grounded in facts.

Link: Organ donation should be part of health discussions, Ethics Forum, American Medical News, May 31, 2010



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