Ethical considerations in the use of pre-mortem interventions to support deceased organ donation: A scoping review

Weiss, Matthew J.; Beinum, Amanda van; Harvey, Dan; Chandler, Jennifer A.

doi:10.1016/j.trre.2021.100635

Cited by 12 publications

(24 citation statements)

References 106 publications

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“…Safeguarding end‐of‐life experience for MAiD patients in the ODE context requires active monitoring, given the potential for changes to the benefit/harm balance with these, sick, vulnerable patients, unlike unconscious withdrawal of life‐sustaining therapy patients. Examples include burdensome assessments during their final days of life, painful interventions, the presence of unknown healthcare teams during MAiD, a different setting for MAiD, changes to the family's experience, and bereavement due to the removal of the body for several hours 59,77,92,95,99,100–116 …”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…Examples include burdensome assessments during their final days of life, painful interventions, the presence of unknown healthcare teams during MAiD, a different setting for MAiD, changes to the family's experience, and bereavement due to the removal of the body for several hours. 59,77,92,95,99,[100][101][102][103][104][105][106][107][108][109][110][111][112][113][114][115][116] The Dutch guideline incorporates choices about varying levels of premortal intervention burden as an explicit part of the donor pathway consent process, with the patient deciding the level of burden they wish to endure and OPO representatives then deciding which organs can be procured based on the premortal interventions appropriate to this level of imposed burden. 59 In contrast…”

Section: Eligibility and Safeguardsmentioning

confidence: 99%

See 2 more Smart Citations

Practice and challenges for organ donation after medical assistance in dying: A scoping review including the results of the first international roundtable in 2021

Raemdonck

Neyrinck

Desschans

et al. 2022

American Journal of Transplantation

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Eligibility and Safeguardsmentioning

confidence: 99%

See 1 more Smart Citation

Practice and challenges for organ donation after medical assistance in dying: A scoping review including the results of the first international roundtable in 2021

Raemdonck

Neyrinck

Desschans

et al. 2022

American Journal of Transplantation

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“…47 A recent review of the ethics of antemortem interventions did not discover any reports that described the impact of including antemortem details in a real-world donation registry. 49 However, in 2021, Scotland introduced opt-out legislation, 50 which assumes authorization to “type A” antemortem interventions (routine investigations, eg, blood sampling, ultrasound scanning), but additional authorization is required from the SDM for “type B” procedures (eg, biopsy) that may pose a risk to the patient. It is too early to draw any conclusion on the impact of this approach on donation decisions, but answers to arguments about the clarity of consent may be found here in due course.…”

Section: Intended Audience and Applicationmentioning

confidence: 99%

Organ and Tissue Donation Consent Model and Intent to Donate Registries: Recommendations From an International Consensus Forum

Walton

Pérez‐Blanco

Beed

et al. 2023

Transplantation Direct

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Background. Consent model and intent to donate registries are often the most public facing aspects of an organ and tissue donation and transplantation (OTDT) system. This article describes the output of an international consensus forum designed to give guidance to stakeholders considering reform of these aspects of their system. Methods. This Forum was initiated by Transplant Québec and cohosted by the Canadian Donation and Transplantation Program partnered with multiple national and international donation and transplantation organizations. This article describes the output of the consent and registries domain working group, which is 1 of 7 domains from this Forum. The domain working group members included administrative, clinical, and academic experts in deceased donation consent models in addition to 2 patient, family, and donor partners. Topic identification and recommendation consensus was completed over a series of virtual meetings from March to September 2021. Consensus was achieved by applying the nominal group technique informed by literature reviews performed by working group members. Results. Eleven recommendations were generated and divided into 3 topic groupings: consent model, intent to donate registry structure, and consent model change management. The recommendations emphasized the need to adapt all 3 elements to the legal, societal, and economic realities of the jurisdiction of the OTDT system. The recommendations stress the importance of consistency within the system to ensure that societal values such as autonomy and social cohesion are applied through all levels of the consent process. Conclusions. We did not recommend one consent model as universally superior to others, although considerations of factors that contribute to the successful deployment of consent models were discussed in detail. We also include recommendations on how to navigate changes in the consent model in a way that preserves an OTDT system’s most valuable resource: public trust.

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“…Or a patient may wish to donate, but not if it required a significant delay in withdrawing life sustaining treatment, or involved pre-mortem interventions that carried particular risks. Weiss et al found that the majority of authors in their scoping review did not view a previously expressed willingness to donate as including consent for pre-mortem interventions, 12 although a qualitative interview study found that some NHS staff thought differently. [10] Either way, further evidence of wishes with regard to these aspects would be valuable.…”

Section: Ethical Implicationsmentioning

confidence: 99%

Proposal to support making decisions about the organ donation process

Moorlock

Draper

2022

J Med Ethics

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In this paper, we propose a novel approach to permit members of the public opportunity to record more nuanced wishes in relation to organ donation. Recent developments in organ donation and procurement have made the associated processes potentially more multistaged and complex than ever. At the same time, opt-out legislation has led to a more simplistic recording of wishes than ever. We argue that in order to be confident that a patient would really wish to go ahead with the various interventions and procedures that now accompany organ donation, more nuanced information than a simple ‘yes’ or ‘no’ may be required. This is of particular importance for donation after circulatory death, where some interventions to facilitate donation occur when the patient is still alive. We propose the implementation of an online form to allow people to record more nuanced wishes in relation to donation, including an indication of competing wishes and how these should be weighed into decision-making. We argue that this approach will promote autonomous decision-making for the public, potentially reduce difficulties that family members encounter at the time of organ donation, and should make medical staff more confident that they are truly acting according to the wishes and best interests of their patients.

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Ethical considerations in the use of pre-mortem interventions to support deceased organ donation: A scoping review

Cited by 12 publications

References 106 publications

Practice and challenges for organ donation after medical assistance in dying: A scoping review including the results of the first international roundtable in 2021

Practice and challenges for organ donation after medical assistance in dying: A scoping review including the results of the first international roundtable in 2021

Organ and Tissue Donation Consent Model and Intent to Donate Registries: Recommendations From an International Consensus Forum

Proposal to support making decisions about the organ donation process

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