Family veto in organ donation: the experiences of Organ and Tissue Donation Coordinators in Ontario

Abstract

Purpose In Ontario, an individual's registered wish for organ donation is legally valid consent following death. Family veto occurs when the deceased donor's substitute decision-maker (SDM) overrides this consent to donate, evoking a legal and ethical conflict. The objective of this study was to examine the experiences of Organ and Tissue Donation Coordinators (OTDCs) working with SDMs who vetoed a deceased donor's consent for organ donation. Methods Qualitative focus groups were conducted with ten OTDCs in Ontario, Canada who reported experience with family veto. An interpretative phenomenological approach informed data analysis. Themes emerged through team consensus and were further refined through collaborative and reflexive engagement. This article is accompanied by an editorial. Please see Can J Anesth 2021, this issue.

Willingness of intensive care unit patients’ family members to donate organs: A cross-sectional study

“…Our study was similar to Anthony, [ 20 ] who found that the support of other family members resulted in a significant difference in the willingness to sign the COD. These outcomes show that disagreements among family members often cause a failure to solicit organ donation.…”

Much ado about the family veto

“…As clinicians and a clinical ethicist with an academic and clinical interest in organ donation and transplantation, we were intrigued by the article written by Anthony et al, in this issue of the Journal, entitled ''Family veto in organ donation: the experiences of organ and tissue donation coordinators in Ontario''. 1 This research team conducted semi-structured interviews with Ontario Organ and Tissue Donation Coordinators (OTDCs) to better understand their experiences and perspectives regarding family vetoes for organ donation. Although only ten OTDCs participated in the study, the research team ensured the OTDCs were experienced at their role, and that there was a diversity of age and practice location.…”

“…As the authors correctly state: ''SDMs have no legal authority to withhold organ donation authorization if the deceased donor had previously consented''. 1 It is commendable that well-meaning healthcare team members go to great lengths to comfort families at their time of grief. Indeed, some OTDCs in the study recognized the occasional ''acceptable veto.''…”

“…En tant que cliniciens et éthicien clinique ayant un intérêt académique et clinique pour le don et la transplantation d'organes, nous avons été intrigués par l'article d'Anthony et coll., publié dans ce numéro du Journal, intitulé « Veto familial au don d'organes : expériences des coordonnateurs en don d'organes et de tissus en Ontario ». 1 Cette équipe de recherche a mené des entrevues semistructurées de coordonnateurs en don d'organes et de tissus (CDOT) ontariens afin de mieux comprendre leurs expériences et leurs points de vue concernant les vetos familiaux au don d'organes. Bien que seulement dix CDOT aient participé à l'étude, l'équipe de recherche s'est assurée que les CDOT avaient de l'expérience dans leur fonction et que ce groupe avait une diversité d'âge et de lieu de pratique.…”

“…Comme l'affirment à juste titre les auteurs : « Les personnes autorisées à décider au nom d'autrui n'ont pas le pouvoir légal de refuser l'autorisation du don d'organes si le donneur décédé y avait déjà consenti ». 1 Il faut féliciter les membres bien intentionnés de l'équipe de soins de santé qui mettent beaucoup d'énergie à réconforter les familles endeuillées. En effet, certains CDOT dans l'étude ont reconnu qu'occasionnellement ils faisaient face à un « veto acceptable ».…”