Saturday, July 2, 2016

Can a family that has decided to end life support decide a loved one should be a living donor?

Transplantation is a field full of the kind of wrenching discussions that you might expect to find as hypotheticals in a philosophy class. The WSJ follows one such discussion:
The Difficult Ethics of Organ Donations From Living Donors

"The family proposed that doctors put Mr. Osterrieder under anesthesia and perform surgery to remove a kidney for transplant. Like any living donor, he would be expected to survive the procedure. Then, a few days later, the ventilator would be removed and he would be allowed to die.

“Just the feeling something good would come out of this helped us,” says Kim Shuster, 31, one of Mr. Osterrieder’s daughters.

"A labyrinth of federal and state rules and regulations, as well as those of individual transplant centers, guide organ procurement. The family met with the hospital’s ethics committee, spoke with doctors and talked among themselves. Everyone wanted to make sure the choice reflected Mr. Osterrieder’s wishes, but there was also discussion about how the family might feel if their decision made news and strangers, not to mention relatives, criticized them.

"Kathy Osterrieder says she, her children and son-in-law all agreed, “if any of us are not on board, we won’t do this.” Whatever happens, she told them, “we have to survive as a unit.”

"The ethics committee gave its approval, and the hospital reached out to the federally designated organ-procurement service that helps coordinate donations in the region. The organization’s leaders were moved. But when they put out a call to 14 different transplant centers to find a surgeon to perform the operation, “we could not find a surgeon who was willing,” says Kurt Shutterly, chief operating officer of the Center for Organ Recovery and Education, based in Pittsburgh.

"The surgeons didn’t feel it was ethical to remove Mr. Osterrieder’s kidney without his direct authorization, Mr. Shutterly recounts. They also worried, he says, that if a living donor died soon after the procedure, it might jeopardize an institution’s entire transplant program.
"Earlier this year, an Organ Procurement and Transplantation Network and UNOS working committee wrote a report about the ethical considerations of a type of “imminent-death donation,” in which a living donor through a surrogate donates an organ before the planned withdrawal of ventilator support. The committee found that, under certain circumstances, the practice may be ethical, but some people who read the report expressed significant enough concerns that the committee determined, for now at least, that it didn’t want to move forward with trying to change UNOS policy. The report is expected to be posted soon for public comment.

“It is powerful to think that someone at the end of life, who has suffered a lot of illness, would want to do something to help someone else by being a living donor,” says Peter Reese of the University of Pennsylvania, chairman of the OPTN/UNOS ethics committee.

"And yet, despite the fact that offering an organ is an exquisitely personal decision, transplantation is a highly communal process, from the involvement of many medical disciplines in the extraction of the organ to the decision about who receives it. “If all those people don’t agree and we try to push this forward, we run the risk of undermining the whole enterprise,” Dr. Reese says. “Organ transplantation requires public trust to a massive degree.”

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