Response to “Public attitude to imminent death donation”
Year: 2021
Type: letter
Abstract: To the Editor: Mr. Akoh,1 thank you kindly for the review and response to our Survey of Public Attitudes Towards Imminent Death Donation (IDD) in the United States.2 With this manuscript, we had one opportunity to ask a controversial question. The purpose was not to cover all the scenarios but rather the most crucial one before proceeding—should surrogate decisions be made that allow a course of action that would not directly benefit the patient and can potentially cause harm? Over 70% of our 2644 survey respondents would themselves donate or agree to donate on behalf of an incapacitated family member if in a situation like Jason's. We vehemently agree—there needs to be clear mechanisms in place to proceed with IDD. Brown-Saltzman et al. eloquently present the ethical quandaries in a successful case similar to Jason's that would serve as a template.3 We would argue that IDD will expand the definition of who can be an eligible donor, thereby increasing the donor pool further. If the question of utility, efficiency, and justice come into play, then how are we addressing the 30%–40%4 of DCDD donors who did not pass away in time (to donate)? What of all the patients and surrogates who want to donate in a last great act of altruism but are never afforded the opportunity?5 Are they not allowed the benefit of trust in this system that we are bound and obligated to build in a way that would serve them? There is clear evidence that there are harms to our DCDD donor families who were unable to donate and have suffered loss twice over.6 Our survey shows a third of our participants are concerned there may be recovery after brain injury and that physicians would not try as hard to save a life. These two topics are salient points, but they are not new. We know that recovery after withdrawal of life-sustaining care is exceedingly rare for those imminently dying. We care for our patients up to the point we are no longer able to do any more. Only then do we broach the topic of organ donation by a different, unrelated team, and we only procure organs for which we have explicit consent. Our responsibility is to educate the public with the facts as we understand it with the experience we have. One can argue that it is paternalistic to determine what the public is able and not able to understand regarding risk and harm. Let us remember that we subject completely healthy people to the very same risks we are proposing. The difference is that these patients do not have a long life ahead of them. They are imminently dying, and there is no further care we believe our medicine can provide. It is absolutely a difficult decision that loved ones may consider—but we argue that many would and to the betterment to all. It is a consideration that offers our patients a chance to die consistent with the way they lived, contributing to the lives of others. Our study findings suggest that the public is open to considering these scenarios and that this option in organ donation is something the majority could participate in. It serves as the first building block necessary to overcome the oft-referred to barriers to progress. Organ transplantation is now commonplace, standard of care, and an accepted part of our culture. We as a transplant community may be so mired in analysis (over 20 years of publications now), that we become complacent with implementation, lagging behind the modern worldview of our patients. The public's trust goes both ways. We should honor the values they have in their passing just as we do in their living. We are the stewards of their legacy, and in our apprehension to do no harm, we may in fact be far from doing good. The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation.
DOI: 10.1111/ajt.16699
Institution: Baylor College of Medicine
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,300
OpenAlex ID: W3164083492