A Case Study of Family Opposition to Organ Donation

Despite First Person Consent By Tarris Rosell, PhD, DMin, 2011 JD is a 25 year old patient who sustained massive head trauma and neurological injury in a motorcycle accident. He is not brain dead, but after 4 weeks in MICU and several neuro consults, the prognosis for “meaningful recovery” is said to be less than 1%. JD has not regained consciousness, and is apt to remain permanently in a vegetative state. 
His parents are attentive and religious. After consulting with their priest and their son’s doctors, including palliative care specialists and a hospital ethicist, they decide to withdraw ventilator support and tube feedings, and “to allow whatever happens to happen.” A Case Study of Family Opposition to Organ Donation. The parents say they are “placing JD in God’s hands now.” A decision is made to withdraw life support that very evening since the priest is there with them and extended family members have gathered, also, some from long distances. 
 With palliative care involved and since death is anticipated soon after extubation, the MICU nurse manager already had notified the regional organ procurement organization (OPO) for assessment of donor potential. When the OPO representative arrives, she discovers that JD’s driver’s license has a little heart and “organ donor” stamped on the front. The backside is scuffed so as to make illegible any signature or date that might have been there. He had not signed up for the online state donor registry and has no healthcare directives on file. Yet on the basis of his driver’s license, it’s determined that JD had authorized donation, a “first person consent,” leaving no record of revocation or refusal of authorization. 
 The state’s recently revised Uniform Anatomical Gift Act states that, “in the absence of an express, contrary indication by the donor, a person other than the donor is barred from making, amending, or revoking an anatomical gift of a donor’s body or a part if the donor made an anatomical gift . . . . [194.240. 1] 
Although JD is not brain dead, he might qualify to be a donor under the hospital’s “Donation after Cardiac Death” protocol. Further evaluation of the potential donor may take several hours, including tissue testing, reviewing the medical record, external communications, and the medical history interview with next of kin. A Case Study of Family Opposition to Organ Donation. It is already close to 9:00 p.m. when the OPO approaches JD’s family about the donation evaluation that has been ramped up following the parents’ decision to withdraw life support. They had intended that the ventilator be withdrawn an hour ago, but were told by MICU staff that they need to wait for some other healthcare personnel to arrive. Per contractual agreement with the OPO, no one but their representative is allowed to discuss organ donation with families, and MICU staff have been compliant.
 When the OPO representative, with a palliative care physician, ushers the parents into a small conference room, she asks if they are aware that JD’s wishes had been to donate organs and tissue to help others. His parents appear startled and say, “No, we never discussed such things as a family. And we don’t want to talk about it now. Please, ask us what you need to, but quickly. We need to go be with our son in his last moments on this earth. As to removing his organs, we will not permit that. He has suffered enough cuts and needle sticks and bruises. Please let us alone with him now.” Soon they get up and leave the room.
 The OPO representative does not follow the parents back to the bedside, but goes immediately instead to the attending physician. She and the palliative care physician report what had happened with JDs parents, and review with staff the hospital’s policies on DCD and First Person Consent Opposition. She also cites state law: “When a hospital refers an individual at or near death to a procurement organization, the organization may conduct any reasonable examination necessary to ensure the medical suitability of a part . . . . During the examination period, measures necessary to ensure the medical suitability of the part may not be withdrawn unless the hospital or procurement organization knows a contrary intent had or has been expressed by the individual . . . .” [194.265. 3] 
 Meanwhile, JD’s family has come looking for his doctor, wondering why it is taking so long to proceed with their decision to remove all the machines and “get out of God’s way.” Directions: Please write your case study in APA paper format . Discuss this issue in relation to what you know about organ donation. Include any necessary references you need on organ donation. Consider the following question, but do not limit your thoughts to just this question: Should the donation go on in accordance with the wishes of the patient, or in accordance with the wishes of the family to save them further distress? Include other ethical issues in organ donation such as directed donation/conditional organ donation and criteria for being on the transplant list.A Case Study of Family Opposition to Organ Donation.

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It is common for families to reject their patient’s wish to donate organs even when they had documented a decision about donation on the donor register. This paper will present a case study of a patient who had registered as a donor. However, the family, members were against the donation. As a result, the ethical issues and the appropriate decisions when faced with such family’s opposition will also be discussed.

Case Study

A 34-year-old woman presented to the emergency department through emergency medical services after she suffered head trauma after a road accident (car-vs-car collision). When the patient arrived at the ED, her pupils were sluggish and unequal and she was decerebrate to noxious stimuli. It was confirmed that she was having intracerebral swelling. She was also having tachycardia and low blood pressure and as a result, hemodynamic support was started. A CT scan of the head indicated that the patient was having a subdural hematoma. When the neurosurgeon was presented with the findings from the CT scan, she confirmed that surgery would not be beneficial to the patient since the injury was un-survivable. The multidisciplinary team recommended that medical care should include hyperventilation to decrease cerebral edema, and continue until it was possible to establish the level and irreversibility of the injury. She was then admitted to the trauma service ICU and the husband was notified to immediately come to the hospital. The prognosis of the patient was discussed with the husband and the treatment plan included respiratory support and keep the patient under observation for further changes. 24-hours after hospitalization, the patient became hypertensive and developed tachycardia and hypotension. A brain flow study was performed and it was established that there was no flow of blood in the brain.

As a result, the nurse contacted the local organ procurement organization (OPO) since the findings from the brain blood flow and physical examination indicated that the patient was brain dead. A Case Study of Family Opposition to Organ Donation. The organ recovery team arrived and assessed the patient and established she was a suitable candidate to donate an organ. The attending doctor assessed the patient and pronounced that she was brain dead.

The physician suggested to the husband and other family members that organ donation was a feasible option for the patient, which greatly upset the family members. It was established that the patient had registered as an organ donor. The family was taken through grief counseling and educated about brain death and organ donation. However, the mother still felt that the period of time for the donation procedure was so long and argued that even though her daughter wanted to donated organs, he did not have an idea regarding the delays involved and how distressing the procedure was to the family. The mother emphasized that it was not in the patient’s interests to undergo organ donation. This is supported by Shaw et al (2020) who explain that if the delay causes distress to the loved ones of the patient, this should be perceived as the component of a holistic assessment of the best interests of the patient; this means that the organ donation is no longer a part of the best interests for the patient due to the negative effect the delay causes on the family and friends.

Discussion

In such a case, when the family disagrees about organ donation, the appropriate decision is for the donation coordinator to ask the family about their reasons for opposing the donation and attempt to address the family’s concerns. The coordinator should emphasize to the family that the patient had earlier expressed her wish to donate organs and that this donation could save and improve the lives of numerous people with serious illnesses (Miller et al., 2019).A Case Study of Family Opposition to Organ Donation.  The coordinator should also try to oust any myths regarding organ donation that the family may have heard. The family needs to understand that the body of their daughter will not be disfigured and that the donation would not have any effect on the body viewing and funeral arrangements. The pastoral care representative and social worker at the hospital should also be involved to counsel the family to try to help the family agree on the donation.

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The removal of body organs without the family’s consent and the family preventing the donation when the patient had expressed consent breach the right to control an individual’s body after death (Shaw, 2017). Even though there are concerns regarding bodily integrity, when an individual consents for organ donation, this provides consent to have the organs removed even though this would be perceived as a violation of bodily integrity. On the other hand, when the family has a genuine argument regarding that a donation would not be in the best interests of the patient despite the expressed consent, the donation may not be performed since the patient’s consent does not mandate donation (Shaw, 2017). This is why it is necessary to have the family educated about the importance of the donation and how the donation would respect the patient’s final wishes to persuade the family to agree to the donation.

Conclusion

The patient in this case study was involved in a head-collision accident that led to him being declared brain dead. The organ recovery team assessed the patient and established she was a suitable candidate to donate an organ. The patient had registered as a donor, hence consenting to organ donation. However, the family declined. A Case Study of Family Opposition to Organ Donation.  Family refusal would go against the patient’s wishes and autonomy. It is, therefore, necessary to educate the family about the importance of respecting the patient’s wishes autonomy and the benefits associated with the donation. 

References

Miller, J., Currie, S., & O’Carroll, R. E. (2019). ‘If I donate my organs it’s a gift, if you take them it’s theft’: a qualitative study of planned donor decisions under opt-out legislation. BMC public health, 19(1), 1463.

Shaw, D., Lewis, P., Jansen, N., Samuel, U., Wind, T., Georgieva, D., … & Gardiner, D. (2020). Family overrules of registered refusal to donate organs. Journal of the Intensive Care Society, 21(2), 179-182.

Shaw D. (2017). Presumed consent to organ donation and the family overrule. Journal of the Intensive Care Society, 18(2), 96–97. https://doi.org/10.1177/1751143717694916. A Case Study of Family Opposition to Organ Donation.