In countries which have transplant programs utilizing cadaveric organs there will also be a national/state system, which is legal, professional, or both, facilitating organ retrieval. Some countries, many in Europe, have presumed consent (opting out) laws which allow the removal of organs and tissue for transplantation without the need to obtain consent from the next of kin unless the deceased has previously stated that he or she would not wish this to happen. In practice, however, most countries with presumed consent still offer the family the right of veto even though this is not necessarily a legal requirement. The alternative system is one of informed consent (opting in). Here, either the deceased has previously expressed a wish to donate, which the family then honors, or the next of kin make the decision on behalf of the deceased.
In the United States many states have introduced the legislation of required request which makes it mandatory for staff to approach the family about organ donation if the patient is suitable.
Whatever system is in place, religious and cultural beliefs must be respected. Worldwide, the beliefs of major religions pose no difficulties for organ donation as the gift of life is considered to be the ultimate gift. However, the personal feelings of the individual must be respected, as cultural beliefs can have a very strong influence on attitudes to death and the integrity of the body.
Each ICU should have a protocol for organ donation and all grades of staff should be made aware of the steps to follow in the event of identification of a potential donor. The responsibility for actually approaching the family may always be taken by the same people, and it is important that other members of staff know who they are (Stein.. .. .et. . . al 1...9.9.5)■ If there is a transplant co-ordinator, there will already be an established procedure with a service provided for advice and referrals.
Allowing the family to make their decision based on what they know the patient would have wanted is their right. In donating, they have the chance of gaining comfort from the knowledge that some good will have come from the unexpected death (Wa.t.S.0.n,.a.D.d Morgan 19..9..5)■ Donation, in helping others to live, is a positive outcome for family and staff alike, and staff can also gain comfort from knowing that by offering the choice, whatever the outcome, they have done all that they can to support the family.
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