The UK Human Tissue Act and consent: surrendering a fundamental principle to transplantation needs? | Journal of Medical Ethics

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The UK Human Tissue Act and consent: surrendering a fundamental principle to transplantation needs?

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When "consent" is not consent
David W Evans
Published on: 18 May 2017
When "consent" is not consent
Michael Potts
Published on: 18 May 2017

Published on: 18 May 2017
When "consent" is not consent
- David W Evans, Retired physician
Dear Editor,
Potts (1) questions the validity of prospective consent to organ donation as recorded on the organ donor cards in current use in the USA. The situation is no better in this country. "Consent" as recorded on the NHS Organ Donor Register is based on nothing more than a ticked box on a form specifying organs to be taken after death. Such "consent" is surely invalid, being at the very least far from fu...
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Dear Editor,
Potts (1) questions the validity of prospective consent to organ donation as recorded on the organ donor cards in current use in the USA. The situation is no better in this country. "Consent" as recorded on the NHS Organ Donor Register is based on nothing more than a ticked box on a form specifying organs to be taken after death. Such "consent" is surely invalid, being at the very least far from fully informed and arguably based on misinformation - there being no mention of the fact that death for transplant purposes will be certified on different, highly contentious, criteria from those in otherwise universal use.
It may be that a majority of the names on the NHS Organ Donor Register are there because of failure to appreciate, or even consider, this vitally important fact. Almost certainly that will be the case where the names of children are concerned. It may be that the 12 million or so names on that Register will ultimately be seen as testimony to the power of official propaganda in the "media" age. It is certainly not a repository of valid offers of post-mortem organ donation fairly made on a fully informed and mutually understood premise.
References
1. Potts M. When "consent" is not consent. e-letter to J Med Ethics (re Bell MDD. J Med Ethics 2006;32:283-6), 18 May 2006.
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Conflict of Interest:
None declared.
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Published on: 18 May 2017
When "consent" is not consent
- Michael Potts, Associate Professor of Philosophy
Dear Editor,
MDD Bell (1) points out a number of serious ethical problems with "presumed consent" for organ donation in the UK Human Tissue Act 2004. One serious problem is that even in a system of voluntary organ donation, such as the one in the US, true informed consent is not given. Organ donor cards do not make it clear when claiming that the removal of organs takes place after the donor is dead, that the poten...
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Dear Editor,
MDD Bell (1) points out a number of serious ethical problems with "presumed consent" for organ donation in the UK Human Tissue Act 2004. One serious problem is that even in a system of voluntary organ donation, such as the one in the US, true informed consent is not given. Organ donor cards do not make it clear when claiming that the removal of organs takes place after the donor is dead, that the potential "brain dead" donor is not dead in the usual sense of the word. Surgery to remove organs begins with the donor's heart still beating and blood gas exchange continuing in the cells, tissues, organs, and systems of the body. The patient's being on a ventilator does not change the fact that he or she is a living human organism. Families who see their loved ones labeled "dead" when they appear to be very much alive are wisely reluctant to support the removal of organs from their loved ones.
Bell also refers to the continuing controversy over the "brainstem death" criterion in the UK (just as controversy over the "whole brain death" criterion continues in the US). (2) Beside the fact that brain dead individuals still have organic unity, it is not clear that their brains are completely dead. (3) For someone to give consent to organ donation, one would need to be aware that the issue of the proper criteria for determining death has not been settled. Potential donors and their families are not currently informed of these uncertainties. Bell also rightly mentions the uncertainties, both medical and ethical, surrounding "non-heartbeating" organ donation, problems which should be revealed to the families of potential donors.
If there is so much uncertainty over consent in a voluntary system of donation, a system of "presumed consent" is even more morally problematic. Such a system presumes that it is clearly rational and ethical for a person to consent to organ donation, when the evidence indicates that this may not be the case. An "opt out" system will likely be ineffective, especially since potential donors will only be presented with a rosy picture of organ donation. It is almost certain that under "presumed consent," organs will be taken from donors who oppose organ transplantation or who believe that removing vital organs from the "brainstem dead" donor kills the donor. A "presumed consent" system of organ donation makes a mockery of the term "consent" and should be rejected.
References
1. Bell MDD. The UK human tissue act and consent: surrendering a fundamental principle to transplantation needs. J Med Ethics 2006;32:283- 286.
2. Potts M, Byrne PA, Nilges RG, eds. Beyond brain death: the case against brain-based criteria for human death. Dordrecht, The Netherlands: Kluwer Academic Publishers, 2000.
3. Potts M, Evans DW. Does it matter that organ donors are not dead? Ethical and policy implications. J Med Eth 2005;31:406-409.
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Conflict of Interest:
None declared.
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