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Organ donation

Personal Responsibility Within Health Policy: Unethical and Ineffective

23 Sep, 16 | by miriamwood

Guest Post by Phoebe Friesen

Re: Personal responsibility within health policy: unethical and ineffective

If someone who has smoked two packs a day for thirty years and someone who has never smoked but is unfortunate enough to inherit a genetic condition are both in need of heart surgery, who should be given priority?

Should an alcoholic be placed on the liver transplant list, even if they continued to drink against their doctor’s advice?

Does someone who never works out and has poor eating habits have the same right to health care as someone who eats healthy and exercises every day?

Policy makers who are faced with the difficult task of distributing limited resources in health care need to determine which criteria are relevant, and questions related to ‘personal responsibility’ come up time and again. Within the field of medical ethics, many have argued that personal responsibility should be taken into account within health care policy. Advocates suggest that treatments will be more effective or provide longer-lasting solutions if illnesses are not self-caused, and argue that individuals who knowingly take health risks violate their obligation to take care of themselves and should therefore be treated differently. Others argue that there is no place for responsibility in health care policy, pointing out that there is no evidence for different treatment outcomes in individuals who did or did not contribute to their condition, and emphasizing the difficulty, if not impossibility, of determining how responsible someone is for a particular health problem.


Intentionally Exposing Patients to HIV: When Might it be Ethical?

7 Jun, 14 | by BMJ

Guest Post by Bram Wispelwey, Ari Zivotofsky, and Alan Jotkowitz

Much has been made of the fact that over the last two decades HIV has transformed from an inevitable, agonising killer into a controllable chronic disease.  But have we reached a point where infecting someone with HIV in order to avoid other, potentially worse health outcomes might be justified?  In the realm of organ transplantation we found that if we are not yet there, perhaps we should be.

Our paper was in part inspired by what many considered a shocking ruling by former Israeli Chief Rabbi Eliyahu Bakshi-Doron, who decreed that it was consistent with Jewish religious law for HIV-negative individuals to receive HIV-positive organ transplants, even if the evidence indicates a possibility for the recipient to contract the disease.  Many considered this opinion premature because only recently had HIV-positive individuals been found to be good candidates for solid organ transplantation, and doctors in South Africa were still in the early research stages of examining kidney transplantation between HIV-positive individuals.  But in examining the ethical considerations of autonomy, beneficence, non-maleficence, and justice, we argue in our paper that Rabbi Bakshi-Doron’s opinion is ethically sound.

Focusing on the history of HIV in transplantation and using a comparison to current practice with regard to another infectious disease, cytomegalovirus, we demonstrate that disallowing HIV-negative candidates from receiving HIV-positive organs would be a significant limit on patient autonomy.  The elimination of the ban on this type of potentially life-saving (and improving) donation may also represent a more socially just option, as it would expand the donor pool and engender cost savings. HIV-positive to HIV-positive donation will soon be a reality in several countries; it’s time to think about going one step further.


Read the full paper here.

Give the gift of giving – donate someone elses organ or how the current online system for organ donation allows you to sign up others as long as you know a few details about them. Oops.

23 Apr, 12 | by David Hunter

Hattip to Nathan Emmerich for speculating about this on Facebook and then blogging about it here: Organ Donation: Why isn’t there an App for that?

There are a number of ways you can volunteer to donate your organs when you die in the UK, you can sign up when you get a drivers license, you can even sign up when you get a rewards points card at Boots – a pharmacy chain.

You can now sign up online to donate your organs directly at the NHS website, but as Emmerich points out there seems to be a gaping hole in the current system’s security. It appears that the only information you have to provide to prove your identity is your name and date of birth – both relatively easy pieces of information to find out. This means that you could sign up anyone as long as you have this information. They do send out a letter to confirm their consent but seeing as you can enter any address this doesn’t seem to be likely to prevent potential abuses.

I’m honestly surprised I haven’t heard about this already from the Daily Mail, it seems such an obvious and easily criticisable mistake for the NHS to make. Perhaps they don’t have any stock images of people looking confused as their organs are being removed…

Still now that we are here let’s discuss organ donation. There is considerable debate about whether we ought to have an opt in or opt out system of organ donation – this appears to be a new option “an others opt you in system…” And there doesn’t seem to be any way to change your mind and opt out using the online system. This seems well short of any appropriate standard of informed consent, or a useful system for organ donation.

Personally I suspect there is much to recommend changing the default setting to organ donation rather than not donating – think of it as nudging if you will. Certainly if this is all that respecting autonomy requires a robust opt out system will not violate it.

That said I suspect rather than concentrating on the head line question of opt in vs opt out, a fair number of lives could be saved simply by refining and improving the current system.

This also seems to present a moral dilemma for any consequentialists out there, think about all the lives you could save by volunteering your friends organs…

So what kind of system should we have for organ donation?

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