Death determination
-Define DBD
Donation after brain death
Define the medical ethical principle of non-maleficence (Primum non nocere) and why it is the primary concern in living donor transplants
due to the potential of doing medical harm to the donor. Many donors experience significant pain and shortterm disability. The risk of surgical complications in living donor surgery is 5% to 10% risk and the risk of death is 0.5% to 1%[7]
Which organ was the first to transplant?
Kidney in 1954
A prisoner on death row expresses a wish to donate their organs. Critics argue this is a poor use of resources or potentially coercive
While some argue it provides the prisoner a chance for restitution, ethical concerns include whether the prison environment allows for truly free and voluntary consent. There is also the fear that offering sentence reductions for donation could be misused as coercion.
Are children under 12 included in the Dutch Donor Register, and how does consent work for minors?
Yes, but rules vary by age:
Under 12 years: Children cannot register a choice. Parents or guardians decide. If parents disagree, donation does not proceed.
Define DCD
Donation after cardiac Death (after cessation of circulation and respiratory functiond for 2 min.
How are all ethical principles relevant in organ donations?
Autonomy: Respects a person’s right to decide whether their organs may be donated.
Non-maleficence: Ensures donation does not cause harm, especially to living donors or dying patients.
Beneficence: Justifies donation because it saves or improves lives
Justice: Requires fair and non-exploitative allocation of scarce organs.
Since when does NL have opt-out?
2020
A deceased individual in an "opt-out" country (like France or Spain) never registered an objection to donation. However, the grieving family strongly objects to the removal of organs
In practice, most countries (21 of 34 surveyed in the Council of Europe) will not proceed if the family objects, creating a de facto family veto. This happens even in opt-out systems because healthcare professionals often prioritise societal values and traditions of mourning over the strict legal default of presumed consent
In the Dutch Donor Register, and how does consent work for children between 12-18?
Ages 12–16: Children may register a choice. If they say “yes,” parents can still overrule it. If they say “no,” parents must respect this decision.
Ages 16–18: Young people can make their own choice, but they are only automatically included in the register at age 18.
What are the 3 ethical guidelines for organ donation?
1. acts that promote the opportunity to donate viable organs respect the pati ent’s potential interest in becoming an organ donor; (2) the legitimacy of surrogate decision making for critically ill patients whose wishes are unknown extends to decisions regarding organ donation; (3) if real or perceived conflicts arise between the goals of providing optimal endoflife care and the goals of procuring organs, delivery of quality endoflife care should take priority.
Why is automatic registration as “no objection” ethically controversial?
Critics argue it may undermine informed consent if individuals do not fully understand the system. Supporters argue it aligns with utilitarian ethics by increasing organ availability while still preserving the right to opt out.
Explain the difference between "hard opt-out" and "soft opt-out" systems
A "hard opt-out" system legally allows organ donation despite family opposition, whereas a "soft opt-out" system typically defers to the family’s wishes
In the world of kidney transplantations, what determines the patients turn for receiving a kidney?
Waiting time (how long the patient has been on the transplant list or on dialysis)
How does the Dutch Donor Register handle individuals who are legally incapacitated (wilsonbekwaam)
A person must understand the meaning and consequences of donation to register a valid choice. If someone becomes incapacitated later (e.g., due to dementia), their previously registered decision remains valid.
What is the ‘dead donor rule’?’
The dead donor rule emphasizes that the recovery of donated organs shall not cause the donor’s death.
How does utilitarianism define the "right" conduct in the context of maximizing societal good through organ donation
An individual’s donation decision should always be established as best as possible and the individual’s autonomy and right to self-determination should be respected. However, in practice families may overrule this principle because some countries’ legislation allows them to do so. Family overrides raise ethical questions in both opt-in and opt-out systems. Some consider that overriding an active decision to opt-in made by an individual during their lifetime breaches that individual’s autonomy. Others may also question the ethics of allowing a family override in opt-out countries, since arguably an individual is more likely to record a strong objection to donation than they are to record a willingness to donate. Overrides also undermine the philosophy of utilitarianism.
Distinguish between direct financial incentives (e.g., tax credits) and indirect financial incentives (e.g., reimbursement for funeral expenses)
direct financial incentives provide personal monetary gain to donors or their families, while indirect incentives cover related costs without creating net profit.
What is the "gradual approach" to family communication?
Although in two countries HCPs (one country with legislation and one country without legislation or guideline) may deliver information on organ donation in one step, a gradual approach is used in most countries (56.3%), as many families need time to process and accept the death of their loved one before making a decision about organ donation. Decoupling the conversation about a brain death diagnosis from the approach for organ donation is used in 25% of the countries.
When is a donor registration considered invalid for a person who is legally incapacitated?
If the registration was made when the person was already incapacitated, or if the register shows “no objection” for such a person, the registration is invalid. In that case, the physician asks the family or legal representative to decide.
What is Intensive Care to Facilitate Organ Donation (ICOD), and how does its communication process differ from standard Donation after Brain Death (DBD) pathways?
refers to the initiation or continuation of intensive care measures specifically to maintain the potential for organ donation. This is applied to patients who have suffered a devastating brain injury where further active treatment is considered futile and death is anticipated.
In standard DBD, the family is typically approached for donation only after death has been officially confirmed. However, in the ICOD pathway, this discussion must take place before the patient dies
Contrast obligatory altruism with supererogatory altruism and explain how this distinction affects the moral argument for charging for organs
Obligatory altruism is defined as a moral duty to help others. Supererogatory altruism is defined as morally good, but it is not morally requiredgoing “above and beyond” one’s duty. The act that maximizes good consequences for all of society is known as utilitarianism[3].
In 2012, The Working Group on Incentives for LivingDonation developed guidelines for development of aregulated system of incentives for living and deceased donation, what does it entail;
These guidelines state that each country
should have a regulatory and legal framework for
implementing incentives and the entire process must
be transparent and overseen by international and
governmental authorities
According to the 2012 Ethical and Policy Considerations, what should happen if a conflict arises between providing optimal end-of-life care and the procurement of organs
if real or perceived conflicts arise between the goals of providing optimal endoflife care and the goals of procuring organs, delivery of quality endoflife care should take priority. The dead donor rule emphasizes that the recovery of donated organs shall not cause the donor’s death.
If the registration was made when the person was already incapacitated, or if the register shows “no objection” for such a person, the registration is invalid. In that case, the physician asks the family or legal representative to decide.
If a person is registered as having “no objection,” donation may still be stopped if the family can provide strong and credible reasons that this registration does not reflect the deceased person’s true wishes. In such cases, the individual will not become a donor.