PT - JOURNAL ARTICLE AU - Joseph A Raho AU - Katherine Brown-Saltzman AU - Stanley G Korenman AU - Fredda Weiss AU - David Orentlicher AU - James A Lin AU - Elisa A Moreno AU - Kikanza Nuri-Robins AU - Andrea Stein AU - Karen E Schnell AU - Allison L Diamant AU - Irwin K Weiss TI - Ethics of organ procurement from the unrepresented patient population AID - 10.1136/medethics-2019-105584 DP - 2019 Sep 10 TA - Journal of Medical Ethics PG - medethics-2019-105584 4099 - http://jme.bmj.com/content/early/2019/09/09/medethics-2019-105584.short 4100 - http://jme.bmj.com/content/early/2019/09/09/medethics-2019-105584.full AB - 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.