Complex Ethical Issues with Organ Procurement and Donation Following Recent Regulatory Changes

Abstract: Changes in regulatory requirements regarding organ procurement and donation have increased Organ Procurement Organizations' (OPO) incentives to maintain market share, win government contracts, and grow the number of organs procured and transplanted. These changes are felt on hospital floors as long-standing policies and standard procedures are altered to meet the current environment, yet at the same time serve to highlight the ethical challenges that predate the regulatory changes. This multidisciplinary panel with an ICU physician, clinical ethicists from different professional backgrounds, and an ethics administrator will discuss the changing landscape of organ procurement and donation in the United States, with an emphasis on best practices in the face of new challenges, and re-engaging awareness on the ethical issues that remain despite the regulatory changes. The panelists represent different health systems with multiple locations and varying patient populations.
The first panelist will explore conflicts of interest between various stakeholders in the organ procurement process and the ethical challenges between OPOs, hospital policy, and clinician conscience. The second panelist will share a physician’s perspective on best practices to avoid blurring the lines between the treating team and the OPOs. The third panelist will contrast varying laws governing organ procurement throughout the United States in the context of the original intent of the Uniform Anatomical Gift Act. The final panelist will discuss ethical considerations for organ donation in vulnerable populations, including patients who are unidentified and lack representation, highlighting the tensions between values and priorities held by OPOs, hospitals, and clinicians.