First-Person Authorization and Family Objections to Organ Donation

In the United States, individuals who authorize organ donation through various mechanisms make a legally binding decision that only they may revoke. When a person who has given first-person authorization for organ donation becomes eligible to donate organs, according to laws across the United States, their next-of-kin should be informed, not asked, about the impending organ procurement. Despite this, sometimes families are asked for permission to proceed with donation, or they express unsolicited objections to donation. Some scholars and activists argue for the importance of honoring first-person authorization and not accepting what are sometimes called "family overrides" or "family vetoes" of donation. We consider two arguments for this view, the respect-for-wishes and the prevent-harm arguments and defend a more nuanced approach to family objections to organ donation in the presence of first-person authorization. We also examine the role of families or legally authorized representatives in making decisions regarding premortem interventions for potential donors who are not yet deceased. We argue that such decisions are about living patients and should be treated like all other clinical decisions that legally authorized representatives make for incapacitated living patients.