courtesy of the New Zealand Herald - www.nzherald.co.nz

Experts: Organ donors have right to decide

10.09.2004
By REBECCA WALSH

Doctors have a moral and legal obligation to follow a person's wish to donate their organs even if it means going against family wishes, two medical ethics experts say.

In a New Zealand Medical Journal article, Professor Grant Gillett and graduate student Jennifer Ngahooro of Otago University's Bioethics Centre said current practice, which allowed next-of-kin to overrule a person's wish to donate, ignored a doctor's ethical duty to the patient.

"One cannot ethically defend this practice, which in effect overrules the individual's autonomous decision and favours the emotionally fraught decision of a relative, made in a time of stress, and often with no or little background knowledge."

New Zealand donor rates are among the lowest in the Western World.

About 400 people are waiting for transplants, 80 per cent of those needing kidneys.

Last year, 19 people died while waiting for transplants.

The Government is considering paying people who donate kidneys, and is reviewing the law governing the use and storage of human tissue for organ transplants, research and teaching.

The main way of identifying donors is through the donor section of the driver's licence and about 1.1 million people - about 42 per cent of licensed drivers - are registered as donors.

But ticking the donor box is taken as an indication of intent and not a valid form of informed consent. Family members can override it.

Professor Gillett, a neurosurgeon at Dunedin Hospital, said that in most cases, the the Human Tissue Act did not require family or informed consent for body parts to be lawfully removed for medical purposes, but the retrieval team always made a "concerted effort to give dominance of choice" to the patient's family or caregivers.

He said a change in approach would increase the donor rate and remove some of the guilt and responsibility felt by people involved.

Relatives were shocked by their sudden loss, and sometimes unsure about the way they should show their love and respect for the dead.

"We can help in this fraught situation by saying something like: 'Your relative has indicated that he/she wanted to be an organ donor. Is there any reason that should not go ahead?"'

The approach respected the wishes of the patient and reduced the emotional burden of a decision on a relative, he said.

"We want to make it as gentle and easy as possible for people to feel they are not doing anything awful to their dead relative by saying yes."

Professor Gillett said the public needed to be educated through a nationwide campaign that relatives had no valid role in overturning a donor's decision, except in exceptional circumstances, which might include them being "deeply upset" by the donation.

In March this year a group of specialists involved in organ donation said there were sound reasons for not removing organs from the bodies of people whose families objected.

"These include an appreciation that bodies are not mere chattels but remain of emotional, spiritual and cultural significance to the family, even in death," they said.

The article, published in the Herald, said organ removal without family consent was contrary to what had been determined to be best practice in New Zealand and Australia.

It was uncommon for families here or in Australia to object to organ donation when it was the expressed wish of the person who had died.