ESOT 2011 Report – Do medical professionals have the right to say no?

Altruistic donation has contributed to the increase in living donor transplantation worldwide. However, the donor’s wishes are sometimes antagonistic to the medical team’s views. In the current age of patient involvement in treatment decisions, where do we draw the line between patient autonomy and medical teams’ unbiased ability to make treatment decisions? How do we reconcile the two aspects if they are contradictory?

Fiona McCaig from Edinburgh illustrated this ethical dilemma with the case of an 82 year-old blood group AB, potential altruistic kidney donor, whose late husband suffered from renal failure.

It was explained that despite an initial reluctance from the team, following an exhaustive list of investigations and a thorough psychiatric assessment, no obvious contraindication to donation was found. The patient was extremely well informed and keen to see this process through.

Given the age of the prospective donor and the potential fallout for the entire living donation programme, discussion at national level was held to ensure acceptance of this donation process. The prospective recipient was also informed and agreed to proceed. The transplant was carried out successfully.

Fiona McCaig explained that as clinicians we are often confronted with patients who have very clear views on how their medical care should be conducted. However, without infringing on patients’ rights and disrespecting their wishes, the medical teams should not be coerced into actions that they are not comfortable with.

Are we right to seek political backing for our decisions? Does any individual decision have to be justified by the ‘bigger picture’? Difficult decisions should be taken with complete transparency and in consultation with patients and independent of any fallout.

It was concluded that altruistic donation epitomises the ethical challenges of living donation. However, these dilemmas should not deter clinicians and one should explore each case on individual merit, unbiased by personal beliefs.

 

Reference:

CC-019 – ALTRUISTIC DONATION: DO THE MEDICAL PROFESSIONALS EVER HAVE THE RIGHT TO SAY NO? Fiona McCaig et al. Royal Infirmary of Edinburgh, Edinburgh, UK