Medical Ethical and Legal Aspects of Transplantology

In countries with established transplant programs, organ transplantation is highly regulated. Organ donation is of particular concern, with legal, medical and social issues related to obtaining organs for transplants without compensation. Many of these problems are overcome through organ registries, where individuals choose to become organ donors. Through these registries, donors can indicate which organs they are ready to donate after their death. The question of whether a person is a registered organ donor can then be indicated on an identity card (such as a driver`s license) authorizing the procurement of organs after death. In the absence of legal consent through organ donor registration, organ procurement representatives are required to consult with their next of kin in order to obtain permission to obtain organ harvesting from the deceased. This is a comprehensive and thoughtful book on legal approaches to organ transplantation that, as far as lawyers are concerned, is strangely lacking to accompany a number of excellent studies on the philosophy and ethics of the subject. But Price is also engaged in these ethical debates and arguments, and compared to many who have explored other distinct areas of modern biomedical practice, he has done so from a broad international perspective; there is (as an example) more in this essay of the rich and vibrant traditions of South America than in many comparable volumes. This is a particularly welcome addition to the emerging library of international biomedical ethics and comparative law. Consent in medical practice is a process riddled with layers of complexity. To some extent, this is inevitable because different medical conditions pose different problems for doctors and patients.

Informed consent and risk assessment are public health issues that have become even more important in the wake of the Covid-19 pandemic. In this article, we identify relevant factors that clinicians should consider when ensuring consent to solid organ transplantation. Consent to a healthy organ transplant is more complex than most surgical and other clinical procedures due to the many factors, complexity of options, and the need to weigh competing risks. We first look at the context in which consent is given by the patient. We then describe the legal principles surrounding consent in medical practice as it applies in the UK and the implications of recent court decisions. The third section highlights the particular complexity of consent to organ transplantation and identifies factors relevant to determining consent to organ transplantation. The fourth section contains practical recommendations. We propose a new “multifactorial” approach to informed consent for transplants, involving risk understanding, effective communication and robust review processes. While understanding risks and communication is obvious, we suggest that it is essential to integrate review processes into the consent process. More specifically, we intend to identify and create discretionary powers in decision-making to better ensure informed consent in practice. Discretion means that medical professionals use their judgment to use legal judgments as a guide, not a rule.

Discretion is further defined by identifying relevant options and the scope of clinical and personal factors in particular transplant decisions. In particular, we also stress the need to pay attention to the institutional dimension in the approval process. To this end, our recommendations reveal a gap in current approaches to consent. It is essential to identify discretion in decision-making processes to determine when patients should be involved. In other words, clinicians and health professionals need to carefully consider when there is room for freedom of direction and where there is little or no room for discretion. Overall, the approach we propose is a modest contribution to the ongoing debate on consent in medicine. The Gazette states that before removing a human organ from a donor`s body before death, a physician must ensure that the donor has approved on Form 1(A) if the parent is a close relative, i.e. mother, father, brother, sister, son or daughter.

Form 1(B) is used for one spouse and Form 1(C) for other family members. It should also confirm the following: Beauchamp T, Childress J. Principles of Biomedical Ethics. 5th ed. Oxford: Oxford University Press; 2001. Price concludes that developed countries that do not allow an increase in the number of organs available for transplantation encourage the development of further organ exchanges. Therefore, the search for supranational responses to needs and regulation is necessary to respect and protect donors, recipients and health professionals, while encouraging donation and increasing the supply of transplantable organs. One of the keys to triggering this reaction is a little autonomy — so that the pre-mortem desires of potential donors are neither frustrated nor accepted — and another is a gentle commercialization trait. Otherwise, Price would advocate a system of mandatory choice and compliance with these decisions, even if they currently involve legally dubious practices – such as elective ventilation. For living donation – it defines who can make a donation without legal formalities. Parents who are allowed to donate include mother, father, brothers, sisters, son, daughter and spouse.

Recently, in the new Gazette, grandparents were included in the list of first parents. Early family members must prove their relationship through genetic testing and/or legal documents. If there are no first relatives, the recipient and donor must obtain special authorization from the government-appointed authorization committee and appear before the committee for an interview to prove that the reason for the donation is purely altruism or affection for the recipient. Less than 20 years ago, clinical transplantation depended on the urgent and poorly standardized removal of kidneys from donors whose hearts had stopped beating and the transplantation of those kidneys into recipients using rudimentary preservation techniques. The growing acceptance of brain death as a key criterion for patient death has recently allowed procurement to become a carefully planned part of transplanting additional kidneys and kidney organs.1 Forty-four states have legally sanctioned the concept of brain death through formal laws, and a precedent has been set in six other states.1 The concept of brain death still generates considerable fear and skepticism. However, in the general population2 and the success of organ procurement, this depends on a clear explanation of the scientific and clinical context to explain brain death-based death to the donor family. Any other course awakens the public suspects that this diagnosis could allow the patient to be stopped prematurely in order to allow faster access to organs that can be harvested. It has been determined that the determination and determination of brain death should be performed by the physician involved in the donor`s primary care, in collaboration with experts in neuroscience.

This team cannot be involved in the organ donation and harvesting process. Members of the transplant team are prohibited from participating in the determination of death. Thus, a risk may be significant in two respects if (i) a reasonable person in the patient`s situation would be likely to attach importance to the risk, or (ii) the physician knows or ought reasonably to know that the patient in question is likely to attach importance to the patient. Significant risk is not definitively defined in terms of percentages, but percentages may be indicative if the risk does not concern a marginal assessment; such an example in Tasmin v Barts Health Trust, where a risk of 1 in 1000 could certainly be considered non-material [16]. Postoperative risks should also be disclosed [17]. The Montgomery Supreme Court provided additional guidance on the interpretation of disclosure requirements at paragraphs 89 to 91 [14]. In particular, the Court held that the materiality/materiality of a risk depends on an “order of magnitude of factors, including the nature of the risk and its impact on the patient” and that the physician`s advisory role involves “dialogue.” Furthermore, Lady Hale pointed out: “It is now generally accepted that the interest protected by the law of neglect is the interest of a person in his own physical and psychiatric integrity, the important characteristic of which is his autonomy, his freedom to decide what should and should not be done with his body.” She also stated that “. It is not possible to consider a particular medical procedure independently of its alternatives. Most decisions about medical care are not simple yes/no answers. Decisions must be made, arguments for and against each of the options considered, and sufficient information must be given for this to be done. The Montgomery Supreme Court developed the law in a more positive, patient-centred direction, rejecting the previous approach to disclosure of information as set out in Sidaway v Board of Governors of the Bethlem Royal Hospital [18].

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