Ethics Center, UCLA Health System, Los Angeles, California, USA
School of Nursing, UCLA, Los Angeles, California, USA.
J Med Ethics. 2019 Nov;45(11):751-754. doi: 10.1136/medethics-2019-105584. Epub 2019 Sep 10.
The shortage of organs for transplantation by its nature prompts ethical dilemmas. For example, although there is an imperative to save human life and reduce suffering by maximising the supply of vital organs, there is an equally important obligation to ensure that the process by which we increase the supply respects the rights of all stakeholders. In a relatively unexamined practice in the USA, organs are procured from unrepresented decedents without their express consent. Unrepresented decedents have no known healthcare wishes or advance care planning document; they also lack a surrogate. The Revised Uniform Anatomical Gift Act (RUAGA) of 2006 sends a mixed message about the procurement of organs from this patient population and there are hospitals that authorise donation. In addition, in adopting the RUAGA, some states included provisions that clearly allow organ procurement from unrepresented decedents. An important unanswered question is whether this practice meets the canons of ethical permissibility. The current Brief Report presents two principled approaches to the topic as a way of highlighting some of the complexities involved. Concluding remarks offer suggestions for future research and discussion.
器官短缺本身就引发了伦理困境。例如，尽管通过最大限度地增加重要器官的供应来拯救人类生命和减轻痛苦是当务之急，但同样重要的是，要确保我们增加供应的过程尊重所有利益相关者的权利。在美国，一个相对没有被审查的做法是，在没有死者明确同意的情况下，从无人代表的死者身上获取器官。无人代表的死者没有已知的医疗保健意愿或预先护理计划文件；他们也没有代理人。2006 年修订的《统一尸体解剖捐赠法》（RUAGA）对从这一患者群体获取器官的问题发出了一个混合的信息，并且有一些医院授权捐赠。此外，在通过 RUAGA 时，一些州包括了明确允许从无人代表的死者获取器官的规定。一个重要的未解决的问题是，这种做法是否符合伦理允许的准则。本简短报告提出了两种有原则的方法来处理这个问题，以此来突出所涉及的一些复杂性。结束语为未来的研究和讨论提供了建议。
