NICE guidance on organ retrieval: misguided or not?

Clin Med. 2012 Dec;12(6):513-6.

Misguided presumptions: British Medical Association (BMA) and National Institute for Health and Clinical Excellence (NICE) guidance on organ retrieval and 'opt out' or 'presumed consent'

Randall F, Downie R.

Source

Isle of Wight NHS Trust. fiona.randall@iow.nhs.uk

Abstract

Three documents have been produced in an attempt to increase the number of organs available for transplant: a National Institute for Health and Clinical Excellence (NICE) clinical guideline, a British Medical Association (BMA) report and a Welsh Government white paper. All three are ethically flawed: NICE and the BMA recommend that whenever there is intention to withdraw life-sustaining treatment and death is expected, patients should instead be stabilised to assess for donation. This is contrary to patients' best interests, the principles of mental capacity legislation and current criteria for accessing intensive care units. Regarding consent, the BMA and Welsh Government recommend an 'opt-out' policy, but consent in law requires information and cannot be 'presumed' or 'deemed' on the basis of failure to express or register 'opting out'. The language of all three proposals is manipulative, and patient trust may be undermined because the doctor's attention must move from the interests of the patient to those of the unknown organ recipients.

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Clin Med. 2012 Dec;12(6):517-9.

BMA and NICE guidance on organ retrieval: neither misguided nor presumptuous.

Neuberger J.

Source

NHS Blood and Transplant, Birmingham. James.Neuberger@nhsbt.nhs.uk

Abstract

Organ donation from deceased donors should occur whenever appropriate: that is, when there is evidence, belief or understanding that donation was the stated wish of the potential donor or would be in accordance with their wishes, is lawful and in line with current guidelines and will not add further distress to the family. This is the underlying assumption of the British Medical Association (BMA) report, National Institute for Health and Clinical Excellence (NICE) Guideline and Welsh Government Assembly Report. For potential donors after circulatory death, it might be necessary to support the potential donor until the wishes of the person and their family are ascertained. Provided that such interventions are reasonable, explained and do not cause distress to the patient and their family, such measures are surely suitable and will also enable donation to occur when appropriate. Publication and adherence to guidelines that have clinical, legal and ethical validity will reassure the public. Organ donation not only improves the length and quality of life of recipients, but also saves resources for the NHS and provides benefit to the donor family.