You Can Have My Organs, If My Family Agree. 

Once again the rather ugly side of those who seek to increase the supply of organs has appeared in the news. In an article published by the BMJ in its ‘personal view’ section yesterday Dr Shaw has argued “we should not let families stop organ donation from their dead relatives” (subscription required). He points out that whilst there is no legal mandate on which families can refuse to donate the organs of a recently deceased loved one who has signed up to the organ donor register it is nevertheless the case that doctors do respect the wishes of families who are adamantly opposed to donation. The amounts to around 1 in 10 potential organ donors many, but not all, of which would have gone on to donate and, therefore, save – or at least improve - the lives of others. The story was carried by the Today program, the World at One, and various newspapers across the UK and America and in the medical press.

The trouble with this perspective is that it fails to fully realise the conditional nature of donation. I am a register organ donor but that doesn’t mean I am happy to donate my organs in any and all circumstances. For a start I am only happy to donate when I am dead (or as good as). If, for example, I was in a position where I could donate my organs but there was a particular treatment that had a very low probability of saving my life but, if it failed, would rule out any possibility of donation, I want that treatment. Furthermore, whilst my family are aware of my views (and I theirs), if, when it came to it, they found themselves adamantly opposed to donation then I do not want to donate my organs. I'll say that again: if, on my death, my family found themselves so upset (and I hope they would be at least somewhat upset) that they did not want my organs to be donated then I want – my wish is that - my doctors should respect their wishes. In fact I am not sure that any organ donor would wish to donate in curcumstances that caused great further distress to their families.  

Legal rights and, for that matter, ethical rules are not the be all and end all of morality. I do not think doctors wish to find themselves taking the organs of recently deceased patients in the face of vigorously expressed opposition by recently bereaved families - who are, lest we forget, the patients parents, children, spouses and siblings. And I do not think we need a law to make sure that they do not do so. Rather, those ‘ethicists’ who, in the absence of a law, advocate that they should do so need to reflect on what they think ethics and morality are actually for and what, precisely, their role should be.  

Edit (14/08/12): After writing this post I wrote a not dissimilar 'Rapid Response' to the BMJ article where I highlighted the responsibility of organ donors to discuss their registration on the ODR with their families and seek their support. It is here and there are some other rapid responses here