Organ Retrieval: Everything You Need to Know

Organ retrieval is the extraction of organs from deceased persons for organ transplantations or scientific studies. Despite the importance of organ retrieval and transplantation, Australia still faces a deficit in the demand and supply of organs. In 2014, the rate of organ donation was 16.1 donors per million populations (dpmp), well below the country’s 2018 target of 25 dpmp (Rakhra et al., 2017). According to Neate et al. (2015), the rate of family consent in Australia, which remains at 60 percent, is the main barrier towards organ retrieval. Gore and Osborne (2017) report that Australia has seen a recent increase in organ donations but remains behind other nations and states in America and Europe. In a study to determine the reasons behind family consent and nonconsent, Neate et al. (2015) identify that altruism, pragmatism, and the desire to prevent others from facing similar predicaments drive Australian families to consent organ retrieval. On the other hand, nonconsent decisions are driven by a lack of knowledge about the deceased wishes, religious beliefs, social and cultural factors. The Australian Organ and Tissue Authority notes that increasing family consent is critical in increasing donations. Still, these efforts remain unlikely to meet a target that would fill the gap between organ donation and demand for organ replacement. In this essay, I deploy four ethical principles; autonomy, justice, beneficence, and non-maleficence, to argue the need to perform organ retrieval on all deceased persons in Australia, despite nonconsent from the deceased's families. 

Supporting Arguments 

The four ethical principles; autonomy, justice, beneficence, and non-maleficence support retrieval of organs for the benefit of patients in need. The ethical principle of autonomy is about an individual’s choice in their life. The word "autonomy” has a Greek origin and is formed from a combination of two words; ‘autos’ and ‘nomos.’ ‘Auto’ implies ‘self’ while ‘nomos’ means ‘rule’ or ‘law.’ Therefore, the principle of autonomy is about self-rule. It gives patients the right to be free and make decisions that serve as the ultimate rule in their life. Autonomy dictates that every person has the right to ownership of their body, thus the right to offer their organs for sale or donations. Through this principle, living organ donors are permitted to offer their body organs, such as kidneys, either for commercial purposes or to save the lives of their family and friends in need of new organs. Despite the absolute rights over one’s life, limits on autonomy are established to protect individuals from self-harm. If a donation or sale of organs is deemed to be potentially harmful or having been initiated from coercion, miscalculation, or misinformation, then the principle of autonomy becomes inapplicable (Dalal, 2015). Arrieta (2019) affirms a similar position by elaborating that a working assumption on the principle of autonomy is that patients can make informed decisions. The inability to make such decisions nullifies autonomy. Therefore, it is notable that the principle of autonomy does not bar organ retrieval from a deceased person, even on the objection of family and friends. The opposition should only hold if life is being protected. Once life has been lost, attention should shift to patients who need organs, rather than the deceased who do not need the organs. The patients’ self-rule on their life should end at their death, thus giving way to unwavering organ retrieval. According to Jo Delaney (2018), autonomy should promote patient-centered care and not the concerns of the deceased family. 

The ethical principle of justice requires that all patients with similar conditions be subjected to identical healthcare services (University of Western Australia, 2020). Ethical justice, also translated as fairness in care, protects patients from prejudice or discrimination that might arise from their social status, race, gender, and religious believes. However, it should be noted that every patient needs to be handled differently, depending on their needs and autonomy preferences. Therefore, ethical justice implies more fairness and equity in care than equality of healthcare. In a discussion on organ retrieval, ethical justice is applicable to the intended recipient of the organ or the patient, rather than the deceased or their families. Patients, who are the candidates to receive the retrieved organs, need to be handled in a just and fair way that promotes a prolonged life span. In that essence, it goes that the only viable option to ensure fairness and justice is by providing vital organs needed for survival. Therefore, by ensuring that all organs from deceased individuals are retrieved and availed to the needy patients, the principle of justice and equity in healthcare is maintained. It will amount to injustice and unfair professionalism if potential vital organs from the deceased are wasted, leading to prolonged suffering and death of patients who would have benefitted from the transplants. It is also injustice and unfair when other patients receive such donations, while others miss out on account of organs' unavailability. Retrieving organs from all the deceased individuals, with or without their families' consent, will help eliminate the gap between demand and availability of organs, thus promoting fairness and justice to patients in need of new organs. 

The principles of beneficence and non-maleficence are closely related but distinct in their application. Beneficence is the practice of actions that promotes patient’s health and interest, while non-maleficence is the practice of activities with keen consideration not to harm others but rather do them good (Bester, 2020; Saunders, 2017). In this context, ensuring organ retrieval in all deceased persons promotes the principle of beneficence since it offers patients with potential new organs and improved health conditions, thus improving their health. Failure to retrieve organs from deceased individuals widens the gap between supply and demand for organs, leading to more suffering and deaths. Therefore objections to organ retrieval by family members and heeding to such objections by medical professionals go against beneficence. From a similar perspective, organ retrieval in adheres to the principle of non-maleficence since it neither harms the deceased nor their families. Contrary to any possible harm, the retrieval promotes the ethical principle of non-maleficence by promoting the spirit of doing good to patients by assuring an adequate supply of organs. 

Rebuttals 

Opponents of organ retrieval argue that promoting organ retrieval in nonconsent cases from family members risks the life and quality of care offered to patients. They explain that patients under terminal ailments may get a poor quality of services from practitioners who anticipate harvesting the deceased organs. The concern arises from the idea that there exists a conflict of interest among physicians who provide end-of-life care and simultaneously await to retrieve organs (Van Haren et al., 2020). Unethical healthcare providers may also accelerate the deaths of terminally ill patients if other patients urgently need their organs. Besides, critics argue that dishonoring family requests disregards such families' religious and cultural beliefs, thus going against philosophies that promote culturally sensitive care. Such beliefs are particularly common among the Arabic-speaking communities in Australia (Ralph et al., 2016). 

Deconstruction of Rebuttals 

Despite the valid concerns, it is noteworthy that organ retrieval promotes patients' and the community's general good rather than promoting their suffering and death. Honoring nonconsenting family members widens the gap between demand and supply of organs, thus increasing suffering and death of patients who would have benefitted from the retrievals. Lee et al. (2018) demystify the argument of conflict of interest through a study with participants from Australia and New Zealand (ANZ). The authors conclude that ICU doctors in ANZ are morally neutral after recognizing the importance of organ donation and the need for quality end-of-life care. However, to eliminate possible rifts between the deceased's' families and healthcare providers, common ground needs to be forged to promote consensus. In a study conducted in nine ICU units with a follow up from the Organ and Tissue Donation Service in New South Wales Australia, Potter et al. (2017) propose the COMFORT intervention strategy to solve such stalemates. The strategy involves family conversations, led by designated requesters and healthcare givers in a balanced approach. Communication experts in the health profession should guide the delicate discussions. Citerio et al. (2016, p. 305) argue from a similar perspective by suggesting that organ donation discussions should start early and be offered to all patients at the end-of-life care plan. However, families are not the only barrier to organ retrieval. In a study conducted from 12 ICU units in Australia, Macvean et al. (2018) report that physicians support organ donation but do not consider it an end-of-life life element. The belief implies that the conversation should start among the healthcare providers before being rolled out to families and patients. 

Conclusion 

Organ retrieval in Australia should be performed on all deceased persons despite objections from their loved ones. The gap between demand and supply of organs used in transplant and scientific studies continues to rise in Australia, thus calling for an intervention that may reduce this healthcare dilemma. Only 60 percent of families consent retrieval of organs from their deceased family members, indicating that a significant number of potential donors have their organs wasted due to lack of consent. To promote the principles of justice, beneficence, and non-maleficence, the retrieval should be mandated to avail vital organs needed to end suffering and increase patients' lifespan. However, a conversation between families of the diseases should also be ventured as a possible tool to promote consensus among families and healthcare professionals. 

References 

Arrieta, I. V. (2019). Autonomies in interaction: Dimensions of patient autonomy and non-adherence to treatment.  Frontiers in Psychology ,  10 .  https://doi.org/10.3389/fpsyg.2019.01857 

Bester, J. C. (2020). Beneficence, interests, and wellbeing in medicine: What it means to provide benefit to patients.  The American Journal of Bioethics ,  20 (3), 53-62.  https://doi.org/10.1080/15265161.2020.1714793 

Citerio, G., Cypel, M., Dobb, G. J., Dominguez-Gil, B., Frontera, J. A., Greer, D. M., Manara, A. R., Shemie, S. D., Smith, M., Valenza, F., & Wijdicks, E. F. (2016). Organ donation in adults: A critical care perspective.  Intensive Care Medicine ,  42 (3), 305-315.  https://doi.org/10.1007/s00134-015-4191-5 

Dalal, A. R. (2015). Philosophy of organ donation: Review of ethical facets.  World Journal of Transplantation ,  5 (2), 44.  https://doi.org/10.5500/wjt.v5.i2.44 

Gore, A., & Osborne, S. (2017). New ACORN Guideline: Perioperative nursing management of posthumous organ procurement.  ACORN: The Journal of Perioperative Nursing in Australia ,  30 (1), 56-59.  https://search.informit.com.au/documentSummary;dn=628097272368261;res=IELHEA 

Jo Delaney, L. (2018). Patient-centered care as an approach to improving health care in Australia. Collegian ,  25 (1), 119-123.  https://doi.org/10.1016/j.colegn.2017.02.005 

Lee, Y. Y., Ranse, K., Silvester, W., Mehta, A., & Van Haren, F. M. (2018). Attitudes and self-reported end-of-life care of Australian and New Zealand intensive care doctors in the context of organ donation after circulatory death.  Anesthesia and Intensive Care ,  46 (5), 488-497.  https://doi.org/10.1177/0310057x1804600510 

Macvean, E., Yuen, E. Y., Tooley, G., Gardiner, H. M., & Knight, T. (2018). Attitudes of intensive care and emergency physicians in Australia with regard to the organ donation process: A qualitative analysis.  Journal of Health Psychology , 135910531876561.  https://doi.org/10.1177/1359105318765619 

Neate, S. L., Marck, C. H., Skinner, M., Dwyer, B., Mcgain, F., Weiland, T. J., Hickey, B. B., & Jelinek, G. A. (2015). Understanding Australian families’ organ donation decisions.  Anesthesia and Intensive Care ,  43 (1), 42-50.  https://doi.org/10.1177/0310057x1504300107 

Potter, J. E., Herkes, R. G., Perry, L., Elliott, R. M., Aneman, A., Brieva, J. L., Cavazzoni, E., Cheng, A. T., O’Leary, M. J., Seppelt, I. M., & Gebski, V. (2017). COMmunication with Families regarding ORgan and Tissue donation after death in intensive care (COMFORT): Protocol for an intervention study.  BMC Health Services Research ,  17 (1).  https://doi.org/10.1186/s12913-016-1964-7 

Rakhra, S. S., Opdam, H. I., Gladkis, L., Arcia, B., Fink, M. A., Kanellis, J., Macdonald, P. S., Snell, G. I., & Pilcher, D. V. (2017). Untapped potential in Australian hospitals for organ donation after circulatory death.  Medical Journal of Australia ,  207 (7), 294-301.  https://doi.org/10.5694/mja16.01405 

Ralph, A. F., Alyami, A., Allen, R. D., Howard, K., Craig, J. C., Chadban, S. J., Irving, M., & Tong, A. (2016). Attitudes and beliefs about deceased organ donation in the Arabic-speaking community in Australia: A focus group study.  BMJ Open ,  6 (1), e010138.  https://doi.org/10.1136/bmjopen-2015-010138 

Saunders, B. (2017). First, do no harm: Generalized procreative non-maleficence.  Bioethics ,  31 (7), 552-558.  https://doi.org/10.1111/bioe.12366 

The University of Western Australia. (2020, February 14). Clinical ethics information: About ethics . Retrieved August 20, 2020, from  https://guides.library.uwa.edu.au/Clinicalethics 

Van Haren, F. M., Carter, A., Cavazzoni, E., Chapman, M., D'Costa, R. L., Jones, S. L., McGee, A., Moodie, S., Nunnink, L., O'Leary, M., Opdam, H., Radford, S., Turner, A. J., & Martin, D. (2020). Conflicts of interest in the context of end-of-life care for potential organ donors in Australia. Journal of Critical Care ,  59 , 166-171.  https://doi.org/10.1016/j.jcrc.2020.06.016