Ethics of Organ Donation

[Louise Henaut, BSN, CNA, RN]

Hey! I have to write a paper on a case study that my professor produced and I chose the one about organ donation because I immediately had a certain opinion on it and knew what I wanted to write about. The only problem is I'm not totally clear on the legal issues pertaining to the issue in the case study and while writing my paper I want to make sure I am making a stance that is legally correct. The section I am confused on is this:

"When the OPO representative arrives, she discovers that JD's driver's license has a little heart and "organ donor" stamped on the front. The backside is scuffed so as to make illegible any signature or date that might have been there. He had not signed up for the online state donor registry and has no healthcare directives on file. Yet on the basis of his driver's license, it's determined that JD had authorized donation, a "first person consent," leaving no record of revocation or refusal of authorization."

The parents in the case study say they do not want to their son to be an organ donor so basically my paper is on whether or not it is ethical to go through with the organ donation on request of the patients previous decision to be an organ donor or respect the requests of the parents and the lack of further evidence that the patient is a verified organ donor. For me personally, I would follow the decisions of the patient and go through with the organ donation and I know what I want to write about, but I am having a hard time understanding the legality of the situation. I am also confused on what "first person consent" is because upon looking it up it says it means the person signed up to be an organ donor but the case study says "he had not signed up for the online state donor registry". It later says this:

"The state's recently revised Uniform Anatomical Gift Act states that, "in the absence of an express, contrary indication by the donor, a person other than the donor is barred from making, amending, or revoking an anatomical gift of a donor's body or a part if the donor made an anatomical gift . . . . "

Can someone help put this into easier english lol...Thank you so much!! Any personal opinions is totally welcomed to help form my argument.

[idkmybffjill]

It sounds like the patient indicated that he would like to be an organ donor while renewing or getting his license at the DMV. However, he was never registered for the separate online donor registry, where you can indicate what organs and tissues you would like to donate and such. Perhaps because at the time the registry and signing up at the DMV was not connected together. So you could do one without the other. However, it was "first person consent" to sign up at the DMV and get it on his license even if he didn't go a step further and actually register.

The quoted part is pretty much just saying that unless the person has made some type of documented statement that they no longer wanted to be an organ donor after signing up (or made some type of effort to start the process of removal), then another person can not revoke or alter the first person's permission. (And probably the other way around--if someone has not indicated they want to be an organ donor, another person cannot give permission to donate that person's organs without some type of permission from him or her for another person to make that decision.)

[Horseshoe, BSN, RN]

The quoted part is pretty much just saying that unless the person has made some type of documented statement that they no longer wanted to be an organ donor after signing up (or made some type of effort to start the process of removal), then another person can not revoke or alter the first person's permission. (And probably the other way around--if someone has not indicated they want to be an organ donor, another person cannot give permission to donate that person's organs without some type of permission from him or her for another person to make that decision.)

In most states, in the absence of a stated desire to donate organs, or the absence of an expressed desire that organs NOT be donated, the next of kin or POA can make the decision to donate organs. This is done every single day in this country.

[idkmybffjill]

In most states, in the absence of a stated desire to donate organs, or the absence of an expressed desire that organs NOT be donated, the next of kin or POA can make the decision to donate organs. This is done every single day in this country.

That makes sense really. Probably should have thought about it more.

[bugya90, ASN, BSN, LVN, RN]

I just listened to a lecture from our organ procurement company at work so I'll tell you what they said. The heart on your DL is considered patient consent. The procurement agency will contact the DMV and get a copy of the signed form from when the patient requested to be a donor and have the heart on their DL. The procurement agency will approach the next of kin with this form and discuss donation in a positive tone (this is what the patient wanted, the patient wanted to make this easier for you so he signed this form himself and made the choice already, he. can save others, etc). She did say if the parents or next of kin are throwing a big fit and it seems like donation may do more harm than good and traumatize the family then they won't go through with the donation. However, most of the time when they approach the family in a positive tone and explain to them how the patient wanted this then they agree to donation. I'm not sure if that helps you at all.

[Here.I.Stand, BSN, RN]

In my state, the donation can proceed if there is evidence of the pt's wishes to donate. A donor designation on the driver's license can override the family's wishes -- EXCEPT if the pt is a minor. A minor child requires consent from the guardian.

I'm not a lawyer, but I would think the driver's license notation would carry weight over an online form. A driver's license application or renewal is done in the presence of DMV staff and requires proof of identity. ANYONE can go online and enter someone's information.

[Here.I.Stand, BSN, RN]

I'll add that my state's verbiage is virtually identical to the statute you copied here. That's what it means: if a person age 18+ is DD'ed on their license, that IS consent. Nobody has the authority to revoke that consent in the pt's stead.

[Louise Henaut, BSN, CNA, RN]

yes this helped thank you!!!

[/username, BSN, RN]

This is a great question. Generally speaking, donor designation (which is what you're describing - when someone indicates they want to be a donor, which is the most common way people indicate that decision), sits in estate and gift law in most states. The reason is that it is treated much like a will. It does not go into effect until the person dies, and the ONLY ONLY ONLY ONLY ONLY ONLY person who can amend or change that in any way is the person who made that decision. In fact, the OPO has a legal and ethical obligation to honor that person's decision.