Assessing the ethical and practical wisdom of surrogate consent for living organ donation.

INDIVIDUALS OFTEN DECLINE TO SIGN ORGAN DONOR cards out of fear that their organs will be procured prematurely. To reassure these individuals, procurement policy in the United States allows adults’ organs to be procured only after their deaths or, in the case of nonvital organs, with their consent. Despite these limitations on the procurement of adults’ organs, many individuals still decline to become organ donors. As a result, US waiting lists for solid organs have grown to more than 80000 people. Numerous strategies have been proposed to encourage potential donors, including payment for organs and paying for donors’ funeral expenses. Alternatively, some have proposed to expand the pool of potential donors by redefining death as the loss of cerebral cortex, or “higher” brain function. Although this approach has been endorsed by some commentators, it has been rejected by all states, which continue to define death as the irreversible cessation of either cardiopulmonary function or all brain function, including brainstem function. Others propose to expand the pool of potential donors by allowing surrogates to donate the organs of patients in persistent or permanent vegetative state (PVS). Surrogates might also be allowed to donate the organs of terminally ill patients who cannot make their own medical decisions. Permitting surrogates to donate the organs of terminally ill patients or patients in PVS would change organ procurement policy in 2 important ways: surrogates could donate adult patients’ organs before they are legally dead and depending on which organs are donated, organ procurement might cause patients’ deaths. Should these changes be introduced to current organ procurement policy?