A patient is added to the national organ donation waiting list every 10 minutes in the U.S., with more than 75,000 people now hoping to be called. With just 14,075 transplants taking place in the first half of 2017 and one donor having the potential to save eight lives, discussions swirl around what can be done to increase the number of people willing to donate their organs.
Answering that question, though, raises a plethora of ethical questions for physicians to navigate.
For example, if patients or their families make public pleas for an organ and offer a financial reward—known as directed donation—the end result could hurt the equitable distribution of organs among patients in need, lower the efficacy of the transplant system and ruin trust in the overall system.
“Presumed consent” for deceased donors—a policy that makes the assumption that individuals are organ donors unless they have opted out of that choice—has been proven to increase organ donation in Spain. In the United Kingdom, presumed consent for organ donation has been cited as an example of “nudge theory” put into action. According to the theory, subtle policy shifts can make it easier for people to make certain decisions. (The “father of nudge theory,” Richard Thaler, PhD, recently won the Nobel prize for economics.) But the donation would only be ethically appropriate if medical professionals could determine that the deceased person was aware of the presumption and if there were a way to easily access documents that would show that the person had opted out.
Mandated choice, where individuals must express their donation preference when they complete a state-regulated task such as a driver’s license, would only be ethically appropriate if an individual’s choice was made after a meaningful exchange of information about organ donation.
A new educational module is an interactive tool that helps physicians maneuver through these questions. By completing the module, doctors learn what ideas are being discussed and studied as ways to increase the supply of organs available for transplantation. They can also see what key ethical principles should be considered when addressing organ donation. The module then quizzes physicians on how to apply the principles to three patient scenarios involving organ donation.
The module is free to AMA members. AMA PRA Category 1 Credit™ is available.
The AMA Code of Medical Ethics is a living document, updated periodically to address the changing conditions of medicine. The new edition, adopted in June 2016, is the culmination of an eight-year project to comprehensively review, update and reorganize guidance to ensure that the Code remains timely and easy to use for physicians in teaching and in practice.
