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Patient's best interests and presumed consent in ante-mortem organ preservation in end-of-life care

Mohamed Y Rady and Joseph L Verheijde
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DOI: https://doi.org/10.7861/clinmedicine.13-6-630
Clin Med December 2013
Mohamed Y Rady
1Mayo Clinic College of Medicine
2Department of Critical Care Medicine, Mayo Clinic Hospital Phoenix, Arizona, USA
3Department of Physical Medicine and Rehabilitation, Mayo Clinic, Phoenix, Arizona, USA
Roles: professor;, consultant;
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Joseph L Verheijde
1Mayo Clinic College of Medicine
Roles: associate professor in biomedical ethics
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Editor – Littlejohns et al comment on the National Institute for Health and Care Excellence (NICE)'s interpretation of ‘best interest’, which permits presumed consent to ante-mortem organ preservation (Clin Med August 2013 pp 340–3). We argue this interpretation is incompatible with two preconditions established by The High Court of Justice in Ahsan v University Hospitals Leicester NHS Trust in 2006: first, the patient's best interests and second, reasonableness of the proposed care regime.1

Patient's best interests

The Mental Capacity Act stipulates that patient's best interests must include ‘…the beliefs and values that would be likely to influence his decision if he had capacity…’ and ‘…the views of – anyone engaged in caring for the person or interested in his welfare’.1 Familial, cultural and religious values determined the best interest of Ahsan, a Sunni Muslim, who was mentally incapacitated, with end-of-life care. Judge Hegarty QC ruled that ‘most reasonable people would expect…that they would be cared for, as far as practicable, in such a way as to ensure that they were treated with due regard for their personal dignity and with proper respect for their religious beliefs'.1 NICE infers that ‘best interest’ in end-of-life care can include presumed consent to ante-mortem organ preservation for third party interests (recipients). This inference collides with the stipulated ‘best interest’ in the Mental Capacity Act, when preparation and execution of organ procurement transgress religious values. Major world religions forbid organ donation if surgical procurement itself is the proximate causation of death.2

Reasonableness in end-of-life care

Ante-mortem procedures are continued until the surgical procurement team is available to recover organs which can interfere with optimal end-of-life care.3 Donors failing to meet neurological criteria for heart-beating donation are required to undergo elective withdrawal of life support for a controlled circulatory arrest and non-heart-beating donation.4 Circulatory arrest beyond 60 minutes is associated with primary non-function or delayed function of transplanted organs.4 Organ donation euthanasia is recommended in those who are unlikely to develop circulatory arrest within appropriate timelines.5

In conclusion, the arguments of the patient's ‘best interests' and the reasonableness of care regime fail to legally ground presumed consent to ante-mortem organ preservation. Uncorrected, it results in the violation of religious values and human rights of potential donors and surviving families.

Footnotes

  • Please submit letters for the editor's consideration within three weeks of receipt of Clinical Medicine. Letters should ideally be limited to 350 words, and sent by email to: clinicalmedicine{at}rcplondon.ac.uk

  • © 2013 Royal College of Physicians

References

  1. ↵
    The High Court of Justice Queen's Bench Division. Ahsan v University Hospitals Leicester NHS Trust. EWHC 2624 (QB), 2006. lexisweb.co.uk/cases/2006/july/ahsan-v-university-hospital-leicester-nhs-trust [Accessed 31 October 2013].
  2. ↵
    Lancet. Religion, organ transplantation, and the definition of death. Lancet 2011;377:271. doi:10.1016/S0140-6736(11)60076-7
    OpenUrlCrossRefPubMed
  3. ↵
    1. Rady MY,
    2. Verheijde J,
    3. McGregor J
    . Organ donation after circulatory death: the forgotten donor? Crit Care 2006;10:166.
    OpenUrlCrossRefPubMed
  4. ↵
    1. Rady MY,
    2. Verheijde JL
    . No-touch time in donors after cardiac death (nonheart-beating organ donation). Curr Opin in Organ Transplant 2013;18:140–7. doi:10.1097/MOT.0b013e32835e29a8
    OpenUrlCrossRef
  5. ↵
    1. Wilkinson D,
    2. Savulescu J
    . Should we allow organ donation euthanasia? Alternatives for maximizing the number and quality of organs for transplantation. Bioethics 2012;26:32–48. doi:10.1111/j.1467-8519.2010.01811.x
    OpenUrlCrossRefPubMed
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Patient's best interests and presumed consent in ante-mortem organ preservation in end-of-life care
Mohamed Y Rady, Joseph L Verheijde
Clinical Medicine Dec 2013, 13 (6) 630; DOI: 10.7861/clinmedicine.13-6-630

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Patient's best interests and presumed consent in ante-mortem organ preservation in end-of-life care
Mohamed Y Rady, Joseph L Verheijde
Clinical Medicine Dec 2013, 13 (6) 630; DOI: 10.7861/clinmedicine.13-6-630
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