Protecting autonomy in organ procurement procedures: some overlooked issues

Organ procurement personnel in the United States appear to be unaware that the standard practice of asking the surviving families of all classes of potential donors (declared and undeclared) for permission to remove organs and tissues from these individuals is inconsistent with the provisions of most state UAGAs. The majority of these Acts vest first authority concerning the donation of body parts in those individuals whose organs and tissues are needed and judged medically acceptable for removal and transfer. These laws do not give families the right to veto the positive written declarations of dead relatives who have authorized the posthumous taking of their own body parts. Hence, seeking family consent for the removal of body parts from registered donors is unnecessary and inappropriate according to the provisions of most state UAGAs. The primary authority given to individuals under this legislation to control the taking of organs and tissues from their bodies after death arguably rests on the plausible premise that a person's body is his or her property in a significant sense. This gives individuals first authority to control the posthumous disposition of their body parts. Under current retrieval practice, however, families of deceased registered donors are seldom informed about the paramount rights of these individuals and are led to believe that they have final legal authority over the disposition of organs and tissues from these expatients. This is, in effect, an unwitting but nonetheless serious "sellout" of the moral-legal rights of these potential donors. I have attempted to show the weakness of one plausible line of argument for the claim that current retrieval practice with its family priority orientation ought to be continued in unamended form, irrespective of what the law says. I suggested an alternative procedure for approaching the surviving families of registered donors which I believe offers a socially acceptable compromise among three values which enter into competition at the death of a declared donor: (1) saving the maximum number of lives of ESOD victims, (2) respecting and protecting the rights of declared donors, and (3) honoring the needs of the grieving family.(ABSTRACT TRUNCATED AT 400 WORDS)