Only Fully Informed Consent Valid
If a fair offer of organs is to be made by this means, the wording on Donor Cards must clearly be altered to indicate the true circumstances in which the offer may be taken up. And, given the lack of relevant knowledge and comprehension of these matters which seems to prevail in the general population, it may be that the signatory should be required to acknowledge that he has received a full explanation and understands what is involved.
The same considerations regarding explanation and understanding should, of course, apply when a relative is asked for the organs of a loved-one dying on a ventilator. In this tragic context, real comprehension may be particularly difficult to achieve. However, without it there must remain serious doubt about the validity of the consent sought and given. As things are, it may seem paradoxical that such care is taken to ensure that consent to relatively minor therapeutic surgical procedures is given on a fully- informed basis while consent to the evisceration of a relative is usually sought by staff who are not medically qualified but who - perhaps for this reason and their sympathetic demeanour - achieve a higher percentage of assents to the removal of organs than do the doctors.
It is this great concern that ordinary, public-spirited people have not clearly understood which has been one of the great driving forces behind my efforts to protest during the past decade. Because I feel so strongly that the "harvesting" of hearts etc. is a totally unacceptable abuse of the dying which should not be going on in a civilized society, I have the greatest difficulty in understanding why it is so tolerated. The likely explanation, it seems to me, is that the facts are not well enough known. Some of those who do know and understand - such as nurses and anaesthetists who have been involved - have simply left the transplant scene, usually without public comment. Even some of the surgeons who have been responsible for the removal of the organs have confided to me that they were uneasy about it and did not like doing what they felt they had to do. These pangs of conscience, and their expression, give me real cause for optimism. As one of my advisers commented, some doctors seem to prefer to fudge the scientific issues rather than face the facts about what they're really doing. While that attitude is understandable, it cannot be right or successful in the long term. Sooner or later the truth will out. When it does, I trust that we shall see an end to this misconceived and, to my mind, abhorrent activity — one of the wrong directions taken by Medicine as a consequence of unrestricted technological advances.
Original Editor's Note: Dr. D. W. Evans MD, FRCP retired early from his position of Consultant Cardiologist at Papworth Hospital because of his firm conviction on this matter.
FN :* This refers to so-called "cadaveric" donation. A technique for the removal of a part of a liver from a healthy relative, for transplanting into the recipient, has recently been developed in the U.S.A. While this procedure is not free from ethical problems, they are not of the kind which this paper addresses.
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Round Table Discussion
True, the essay on organ transplants was written three decades ago. How has the situation changed, in law? in practice?
How many parents of a young person dying from an accident are presented with the demand to cut out vital organs. Is this a 'good thing' to do?
Note that "Even some of the surgeons who have been responsible for the removal of the organs have confided to me that they were uneasy about it and did not like doing what they felt they had to do". Discuss the moral implications, especially off the last four words.