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Transitions in decision-making authority at the end of life: a problem of law, ethics and practice in deceased donation
  1. Shih-Ning Then1,
  2. Dominique E Martin2
  1. 1 Australian Centre for Health Law Research, Faculty of Law, Queensland University of Technology, Brisbane, Queensland, Australia
  2. 2 School of Medicine, Deakin University, Geelong, Victoria, Australia
  1. Correspondence to Associate Professor Shih-Ning Then, Australian Centre for Health Law Research, Faculty of Law, Queensland University of Technology, Brisbane, Queensland, Australia; shih-ning.then{at}


Where a person is unable to make medical decisions for themselves, law and practice allows others to make decisions on their behalf. This is common at the end of a person’s life where decision-making capacity is often lost. A further, and separate, decision that is often considered at the time of death (and often preceding death) is whether the person wanted to act as an organ or tissue donor. However, in some jurisdictions, the lawful decision-maker for the donation decision (the ‘donation decision-maker’) is different from the person who was granted decision-making authority for medical decisions during the person’s life. To date, little attention has been given in the literature to the ethical concerns and practical problems that arise where this shift in legal authority occurs. Such a change in decision-making authority is particularly problematic where premortem measures are suggested to maximise the chances of a successful organ donation. This paper examines this shift in decision-making authority and discusses the legal, ethical and practical implications of such frameworks.

  • Ethics
  • Donation/Procurement of Organs/Tissues
  • Law
  • End-of-life
  • Decision-making

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  • Contributors S-NT conceptualised and wrote the first draft of the paper. Both S-NT and DM drafted and reviewed the final version of the paper.

  • 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 views expressed in this paper are the views of the authors and do not represent the views of any other group.

  • Competing interests S-NT and DM were members of the Australia National Health and Medical Research Council’s (NHMRC) Organ and Tissue Working Committee.

    DM has received consultancy fees from the Australian Organ and Tissue Authority (AOTA). The views presented here are the authors’ own.

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

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