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Ethical Issues in Critical Care 91

The role of the nurse in the organ donation process of a potential donor. Australian doctors would not
includes supporting the relatives, offering explanation proceed with organ donation without this agreement
and support, in addition to specific therapy delivery in an which is necessary for legal, ethical and medical reasons.
operational sense. In some ICUs, nurses participate in Ensuring family members understand each other’s wishes
seeking consent from relatives for organ donation, a task regarding organ and tissue donation, and improving
77
that has been shown to be very stressful. This stress arises consent rates at the time of request is fundamental to
from the perception that the intrusion may inflate the improving donation rates. Equally important is adequate
distress of the family. However, consenting to organ dona- training of health professionals to sympathetically and
tion in itself does not hinder or prolong the grief process. 78 sensitively approach the grieving family with full knowl-
edge of the process. 66
Research from the USA has noted a significant positive
correlation between higher knowledge levels possessed The experience of several comparable countries demon-
by intensive care nurses and more positive attitudes strates that a coordinated and integrated national
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towards organ donation. In addition, nurses in the UK approach followed by sustained effort will over time see
who were found to hold positive attitudes to organ dona- real improvements in organ donation and transplanta-
tion were more likely to broach and discuss the possibil- tion rates. For example in Spain, the world leader in
80
ity of organ donation with families. However, acceptance organ donation, a central agency drives and coordinates
of the principle of organ donation among ICU nurses was a nationally consistent approach to clinical systems and
higher than support for donation of their own organs or practices and to community awareness and professional
those of a family member. This difference was attributed education; hospitals and their staff have sufficient train-
79
to some nurses not internalising the particular personal ing and capacity to identify all potential donors; and
values, attitudes and interests related to the concept of there are no cost barriers in hospitals that prevent organ
organ donation, therefore not being able to act on their donation proceeding.
beliefs.

This paradox may be reflected in the general public, as an
Australian study found that, while surveys of the general BOX 5.3 The Intruder
public continue to show considerable support for organ In 2009, Francine Wynn explored a philosophical reflection
donation programs, in practice donation rates continue written by John-Luc Nancy on surviving his own heart trans-
81
to be low. In the USA, of those people who state that plant. In The Intruder, Luc raises central questions concerning
they support organ donation, only about half actually the relations between what he refers to as a ‘proper’ life, that is,
consent to donate. 76
a life that is thought to be one’s own singular ‘lived experience’,
Organ donation occurs at a time of great emotional dis- and medical techniques. Nancy describes the temporal nature
tress. The terminology and phraseology in this section are of an ever-increasing sense of strangeness and fragmentation
necessarily factual, and might appear unsympathetic to which accompanies his heart transplant and opens up the
those most closely affected by organ donation. This dis- concept of transplantation in terms of the problematic ‘gift’ of
passionate reporting of events and outcomes should not a ‘foreign’ organ, the unremitting suffering intrusiveness of the
be taken as disrespectful to deceased donors or their fami- treatment regimen, and the living of life as ‘bare life’. Nancy
lies, or to the amazing gift that they make. 55 offers no answer to this dilemma, but instead calls on others to
think about the meaning or ‘sense’ of the prolonging of life and
Australia was a world leader in clinical outcomes for deferring of death. 55
transplant patients in 2010, and over 30,000 Australians
have benefited since transplantation first became a stan-
dard treatment option. More than ninety per cent of Aus-
55
tralians support organ donation. Despite this, Australia The mechanism of consent is proposed as one factor that
has a low rate of donation and consequently a new influences organ donation rates, with many European
national authority, The Australian Organ and Tissue countries using ‘opt-out’ consent processes. In contrast to
Authority (AOTA) was established in Australia in 2009 this, the NHS Organ Donation Taskforce published its
with the mandate to significantly improve organ and second report, The potential impact of an opt out system for
tissue donation and transplantation and to move Austra- organ donation in the UK, in November 2008 with the
lia from a low rate of donation to a leading country conclusion that ‘an opt out system is not right for the UK
performer. This national reform package was based on a at present’, but that the progress of the implementation
World’s Best Practice approach and plan, learning from program should be monitored to see whether the issue
leading country performers such as Spain, France, needs revisiting in future.
Belgium, Austria and the USA. Awareness and engage-
ment of the community, non-government sectors, donor ETHICS IN RESEARCH
families, and others involved in increasing organ and
tissue donation, is paramount with a national approach Respect for ethical codes is a requirement for all those
to in-hospital systems, resources and education of the conducting human research. There are various ethical
community and clinicians. 68 guidelines. For example, the Declaration of Helsinki is
regarded as authoritative in human research ethics. In the
In Australia, organ and tissue donation only occurs UK, the General Medical Council provides clear overall
with the agreement of the next of kin following the death modern guidance in the form of its Good Medical