Source: https://bucklin.org/articles/legal-ethics/organ-procurement-organizations-should-not-reject-a-deceaseds-organ-donation-because-the-family-objects/
Timestamp: 2019-04-24 21:47:24+00:00

Document:
Context. Organ Procurement Organizations (OPOs) frequently refuse a decedent’s gift of organs on the stated basis that a next of kin has not given consent to the OPO’s receipt of the gift.(1) This action by OPO’s is wrong. Can you imagine a hospital refusing a million dollars given to it in a will because the surviving son did not give his consent to his father’s will? Yet that is the legal principle that OPO’s use in rejecting a decedent’s gift of organs for organ transplantation.
By statute in all 50 states: the donor’s gift was explicitly prioritized over the family’s wishes on transplantation.(4) All 50 states enacted the original 1968 UAGA. The core of the statute is simple: new, clear, definite statutory law creating a right of a living person to donate (make a gift) of his/her body, making that right superior to the rights of anyone else. It resolutely allows the living owner of that body asset to distribute it on his/her death, by a simple statement on a driver’s license. The UAGA statute established a legal right of a competent person to donate their organs upon death – no matter what the family thought about it. By statute the decision of the decedent prevails over any supposed property rights of next of kin.
he medical community refused to give full effect to the law. The problem was not legal theory, adverse court interpretations, or lack of clarity of language of the statute. The problem lay in the mis-perception of the medical community about what was need to get organs from the “donor” which the medical community regarded as a dead body.
By 1987 the Uniform Laws Commissioners recognized that the medical community still “just did not get it”. Doctors, who have a penchant for not understanding legal reasoning, seemed confused about a donor who was dead, and about the ability of the decedent to make an effective donation. Hence, the Commissioners prepared a revised UAGA.(5) as word changes to remove the uncertainty of the medical community.(6) The core language is bold. The official comments are the legal equivalent of hitting a person with a 2 x 4 to get their attention.
Several states have amended their statutes to say again in various ways that the gift of organs by a donor does not require the consent of the family.(9) The driving force or pressure behind the legislation does not seem to have been a mob of next of kin shouting in the hallways of hospitals. Instead, to the shame of the OPOs they have lobbied legislatures to get the power it already has.
Where there is a signed donor card, there is no legal excuse for an OPO to seek consent of the next of kin. The state has granted authority for the gift. The family has no superior interest.
Anecdotal evidence shows that it is only the medical community and the OPOs that do not seem to get the message. Virtually everyone outside the organ business believes ORGAN DONOR on their driver’s license is sufficient to complete the donation. Indeed, they are surprised to find the OPOs think the next of kin needs to consent to the donation. The public may not know the words of the statute, (“An anatomical gift that is not revoked by the donor before death is irrevocable and does not require consent or concurrence of any person after the donor’s death.”(10)) but the public understands it.
This statutory language does not take a college graduate to understand. Still, OPOs continue to require the consent of next of kin. There is a startling difference between legal reality and the perception of legality by the OPOs which seek ‘consent’ from the next of kin of a deceased donor.
The OPO is not liable in a civil action for taking the organ without consent of the next of kin. “(C) A hospital, physician, surgeon, . . . or other person, who acts in accordance with this [Act] or with the applicable anatomical gift law of another state . . . or attempts in good faith to do so, is not liable for that act in a civil action or criminal proceeding.” [Emphasis supplied](11). Courts have consistently given the broadest possible reading to this grant of protection to the medical community. The immunity is decided by a court, not by a jury, soon after the suit has been brought. The language of the Minnesota court is typical.
Thus, any lingering doubt by an OPO as to legal liability should be completely swept away by the immunity section of the UAGA (contained in both the 1968 and the 1987 versions). The language of one court in upholding the statutory immunities is instructive.
Thus the data reflects what a lawyer would predict. The OPO need have no fear of suit for taking a decedent’s gift, without consent of survivors, and even against the opposition of survivors.
Utility. Utility refers to the principle that the greatest good should be done for the greatest number of persons. The Task Force on Organ Transplantation took it as assumed that organs are “a national resource to be used for the public good.”(20) Taking the deceased’s donation without rejection of it, even if family members object, is more likely to increase the supply of organs. The public good is increased by the increase in the number of years of quality life available to the population. In addition to years of quality of life, consider cost. It costs less to have a healthy person after transplant than to maintain a sick person for years.
Justice. The OPO in providing justice will accept a donation of an transplantable organ, so as to assure adequacy for those on the list. Justice will also assure equality of supply for those on the transplant list at various times, in diverse parts of the country. Therefore, all OPOs should use a uniform policy of organ gift acceptance, not a policy of organ gift acceptance dependent upon a veto by next of kin.
Justice requires that the OPO consider the transplant patient in the OPO’s decisions to accept/ reject a deceased donor’s organ gift. Representing the interests of the transplant patient is done by accepting the gift of a decedent donor.
Autonomy. Autonomy is the ethical principle of respecting the self-determination of autonomous individuals. It mandates accepting the donor’s gift unless a competing equal or greater autonomy exists. The next of kin’s demand that the OPO reject the gift (i.e., the next of kin’s refusal to consent) is merely a selfish attempt to prevent the autonomous choice of the decedent.
Legal. If the deceased has made an anatomical gift, the OPO has the supreme right to take the organs. There is no legal reason to seek consent of the survivors.
Ethical. There is a moral imperative to accept the gift. An OPO should take a decedent donor’s organ gift, even if the next of kin objects that they do not want a deceased donor’s gift honored. An OPO that seeks the consent of next of kin, when there is a known donation by the decedent, violates the ethical principles of autonomy, utility, and justice.
1. Alexander M. Capron, Reexamining Organ Transplantation, 285 Journal Am Med. Assn. 334, at 335 (No. 3, Jan 17, 2001).
2. UAGA, 8A ULA 15-16 (1968).
3. Perry v. Saint Francis Hosp. & Med. Ctr., 886 F. Supp. 1551, 1557 (D. KS. 1995); see UAGA (1968), Prefatory Note, 8A U.L.A. 64-65 (1993) (recognizing need for comprehensive act addressing organ donation and concluding UAGA, wherever enacted, will eliminate uncertainty and protect all parties); see also Gloria J. Banks, Legal and Ethical Safeguards: Protection of Society’s Most Vulnerable Participants in a Commercialized Organ Transplantation System, 21 Am. J.L. & Med. 45, 67 (1995) (stating UAGA amended in 1987 to better address issues, such as concern over providing “encouraged volunteerism” system with teeth needed to increase supply of transplantable organs); and E. Blythe Stason, The Uniform Anatomical Gift Act, 23 Bus. Law 919, 921-24 (1968) (recognizing legal uncertainties of organ donation laws during pre-UAGA era as providing major basis for adoption of model act).
4. UAGA § 2 (h).
5. UAGA, 8A ULA 2, 30 (Supp. 1991).
6. “Concern had been expressed that donee organizations and hospitals had in some cases been reluctant to rely on a donor card or document of gift if relatives were opposed to the donation. Section 2(h) of the Act makes clear that a gift not revoked by the donor prior to death is irrevocable and does not require the consent or agreement of any person after the donor’s death” Martin D. Begleiter, The Uniform Anatomical Gift Act, Probate and Property 51, at 51-52 (March-April 1989).
7. UAGA § 8 (1987) which restates the 1967 similar provision.
9. Kentucky HB208, passed, signed into law March 8, 2000; KRS 311.237 ( “….the individual’s family members…shall not have any legal standing or authority to modify the decedent’s wishes or deny the anatomical gift from being made….”).
11. § 11(c) in the 1987 UAGA; § 7 (c) in the 1968 UAGA.
13. Daniel E. Gadzala, Anatomical Gifts: Considerations and Critiques, Medical Trial Technique Q. 464 at 478 (Summer 1992).
14. Ramirez v. Health Partners of Southern Arizona, 972 P2d 658(Ct. App. 1999).
15. Williams v. Hoffman, 223 NW2d 844 at 848-49 (WI 1974).
16. Nicoletta v. Eye & Human Parts Bank, Inc., 519 NYS2d 928 (1987).
17. Florida v. Powell, 497 So. 2d 1188 (FL 1986)(statute authorizing medical examiners to remove corneal tissue with consent of next of kin); Georgia Lions Eye Bank v. Lavant, 335 SE 2d 127 (GA 1985) (statute authorizing cornea removal upheld); Nicoletta v. Rochester Eye & Human Parts Bank, 519 NYS 2d 928 (1987) (good faith compliance with UAGA provides immunity to retrieving eyes); Williams v. Hoffman, 223 NW2d 844 (WI 1974)(UAGA immunity upheld against next of kin complaint of mutilation of a corpse.). A continuing listing is found at Anno., Tort Liability of Physician or Hospital in Connection with Organ or Tissue Transplant Procedures, 76 ARL3d 890 and its annual supplements.
18. Dave Wendler and Neal Dickert, The Consent Process for Cadaveric Organ Procurement, 285 Journal of the American Medial Assn. 329, at 332 (No.3, Jan 17, 2001).
19. 1991 Ethics Committee, United Network for Organ Sharing, Principles of Organ and Tissue Allocation and Donation by Living Donors, 24 Transplantation Proceedings (No 5- (October 1992) 2226. Author Bucklin was a member of the subcommittee, which was chaired by Robert M. Veatch, Ph.D. Dr. Veatch is Professor of Medical Ethics, The Kennedy Institute of Ethics, Georgetown University.
20. Task Force on Organ Transplantation, Organ Transplantation: Issues and Recommendations, US Dept of Health and Human Services (1986).

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