Communication Skills to Increase Donor Consent Rate Based on the Concept of “Moral Imperative”

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Excerpt

Shaw et al1 carried out an analysis of allowing families to overrule organ donation intentions. The authors point out that becoming an organ donor is not simply a matter of registering one's intention to donate, but a true desire of the family to honor the wishes of the deceased. In 1 study, 20% of families denied consent for donation.2 Arguments against allowing families to overrule donation are that the overrule disrespects the wishes of the deceased. The main argument of proponents of overrule argue that families might have new information about a patient's refusal to donate. The authors concluded that adopting a no-overrule system may result in detrimental consequences for donation systems and rates.
Improved communication skills are required to improve consent rate so that families do not overrule the wishes of the deceased to donate their organs. Improvement of communication skills must be accompanied by reasoned argument. There are several approaches the healthcare provider can take when confronted with families overruling the deceased wishes. One of these could be based on the concept of “moral imperative”; a strongly felt principle that compelled the deceased to act due to “pure reason.”3 It follows as a corollary that by overruling the wishes of the deceased, the family may not be adhering to “moral law”; a promise made by the deceased to donate. Kant and Smith (1724-1804),3 a philosopher, defined “moral imperative” as strongly felt principle that compelled a person to act.
The main argument of proponents of overrule argue that families might have “new information” about a patient's refusal to donate maybe explained in the theoretical framework of economics. The deceased’s family may well have inadequate or distorted information on the process of organ donation, which could be called “information asymmetry,” where the risk-taking party to a transaction knows more about its intentions than the party paying the consequences of the risk.4 Economists argue that this “inefficiency” results from “information asymmetry.” In case of organ donation, “inefficiency” (allowing more recipients to die on the waiting list) occurs when the family overrules wishes of the deceased.
We propose that healthcare workers faced with a family’s refusal to honor wishes of the deceased may be able to increase the “efficiency” of the organ donation system by understanding the inherent “information asymmetry” that exists in all areas of life. They may also counter argue that by not following the wishes of the deceased would mean that they are not following the “moral law” which would self-defeating and thus contrary to reason.
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