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Ethics of organ procurement from the unrepresented patient population
  1. Joseph A Raho1,
  2. Katherine Brown-Saltzman2,
  3. Stanley G Korenman3,
  4. Fredda Weiss4,
  5. David Orentlicher5,
  6. James A Lin6,
  7. Elisa A Moreno7,
  8. Kikanza Nuri-Robins4,
  9. Andrea Stein4,
  10. Karen E Schnell8,
  11. Allison L Diamant9,
  12. Irwin K Weiss6
  1. 1 Ethics Center, UCLA Health System, Los Angeles, California, USA
  2. 2 School of Nursing, UCLA, Los Angeles, California, USA
  3. 3 Department of Endocrinology, David Geffen School of Medicine, Los Angeles, California, USA
  4. 4 UCLA Ethics Committee, Los Angeles, California, USA
  5. 5 William S Boyd School of Law, UNLV, Las Vegas, Nevada, USA
  6. 6 Department of Pediatrics, David Geffen School of Medicine, Los Angeles, California, USA
  7. 7 Department of Psychiatry, David Geffen School of Medicine, Los Angeles, California, USA
  8. 8 Department of Spiritual Care, UCLA Health, Los Angeles, California, USA
  9. 9 General Internal Medicine and Health Sciences Research, David Geffen School of Medicine, Los Angeles, California, USA
  1. Correspondence to Dr Joseph A Raho, Ethics Center, UCLA Health System, Los Angeles, CA 90095, USA; JRaho{at}


The shortage of organs for transplantation by its nature prompts ethical dilemmas. For example, although there is an imperative to save human life and reduce suffering by maximising the supply of vital organs, there is an equally important obligation to ensure that the process by which we increase the supply respects the rights of all stakeholders. In a relatively unexamined practice in the USA, organs are procured from unrepresented decedents without their express consent. Unrepresented decedents have no known healthcare wishes or advance care planning document; they also lack a surrogate. The Revised Uniform Anatomical Gift Act (RUAGA) of 2006 sends a mixed message about the procurement of organs from this patient population and there are hospitals that authorise donation. In addition, in adopting the RUAGA, some states included provisions that clearly allow organ procurement from unrepresented decedents. An important unanswered question is whether this practice meets the canons of ethical permissibility. The current Brief Report presents two principled approaches to the topic as a way of highlighting some of the complexities involved. Concluding remarks offer suggestions for future research and discussion.

  • Transplantation
  • Donation/Procurement of Organs/Tissues
  • Public Policy
  • Ethics

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  • Contributors JAR, KBS and SGK conceived the article. JAR drafted, edited and approved the final paper. JAL made inquiries to UNOS for data on the practice. DO drafted key sections of the paper with regard to the Revised Uniform Anatomical Gift Act. All authors participated in discussions of the topic, assisted in revision of the manuscript, gave final approval of the version to be published and are accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer The ideas expressed should not be understood to represent the views of UCLA, the UCLA Health System, or the Ethics Committee.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.