Letter to the Editor
The organ donation process: An ethical commitment
El proceso de donación de órganos: un compromiso ético
Francisco del Rio Gallegos, Almudena Escribá Bárcena, Teodoro Grau Carmona
, Alonso Mateos Rodriguez
Corresponding author
Oficina Regional de Coordinación de Trasplantes, Servicio Madrileño de Salud, Consejería de Sanidad de la Comunidad de Madrid, Madrid, Spain
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"apellidos" => "Varela" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572724000274?idApp=WMIE" "url" => "/21735727/unassign/S2173572724000274/v1_202402251056/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "The organ donation process: An ethical commitment" "tieneTextoCompleto" => true "saludo" => "Dear Editor:" "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Francisco del Rio Gallegos, Almudena Escribá Bárcena, Teodoro Grau Carmona, Alonso Mateos Rodriguez" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Francisco" "apellidos" => "del Rio Gallegos" ] 1 => array:2 [ "nombre" => "Almudena" "apellidos" => "Escribá Bárcena" ] 2 => array:4 [ "nombre" => "Teodoro" "apellidos" => "Grau Carmona" "email" => array:1 [ 0 => "teodoro.grau@salud.madrid.org" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 3 => array:2 [ "nombre" => "Alonso" "apellidos" => "Mateos Rodriguez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Oficina Regional de Coordinación de Trasplantes, Servicio Madrileño de Salud, Consejería de Sanidad de la Comunidad de Madrid, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "El proceso de donación de órganos: un compromiso ético" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We have read with interest the letter to the editor entitled “Moral complexity in the organ donation process: a prudential act”<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and felt it necessary to make a few comments on some aspects of its argumentation. Organ transplantation is a life-saving therapy, and patients on the waiting list have no alternative therapy. As intensivists, we are responsible for reducing the number of patients on the waiting list by facilitating the donation process in our units. In fact, Donation-Oriented Intensive Care (DOIC) is a common practice in our units<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and in most developed countries. Fortunately, the debate is well-resolved, and in full compliance with the principles of bioethics, the following aspects could be argued.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Regarding the principle of beneficence: end-of-life decisions should be made primarily based on values rather than facts. For the patient, it represents an opportunity to express values such as solidarity and altruism and may be the best therapeutic option until their poor prognosis is properly assessed. For the family, it provides solace in the face of loss, and for patients on the waiting list, it offers a genuine chance of survival.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Regarding the principle of non-maleficence: DOIC requires ensuring the absence of suffering and the patient’s comfort, as outlined in existing protocols. Therefore, if deemed appropriate, DOIC should consider the possibility of having the patient accompanied by their family at the intensive care unit (ICU) setting. The option to revoke consent for DOIC is mandatory.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Regarding the principle of autonomy: All human beings aspire to live with dignity, as recognized by science, society, and law. A dignified life deserves a dignified death as an inseparable concept. Respecting dignity necessarily involves considering the option to donate each person’s organs, either directly or through representation, thus respecting the patients’ wishes and values. Providing this option is indeed a moral obligation for the health care personnel involved in patient care. Failing to offer it based on compassionate arguments would represent an undesirable paternalistic attitude.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Regarding the principle of justice: the use of ICU resources for DOIC is a matter of cost-opportunity. The moral obligation of health care providers is to allocate resources to a real—not a hypothetical—situation. Choosing a patient for DOIC vs the hypothesis that those resources could be allocated to a patient who might present represents the denial of an opportunity to stay alive in favor of a potential situation that does not exist yet.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">We agree with the authors that the donation process requires a deep understanding and analysis of each patient’s situation. Therefore, SEMICYUC considers DOICs necessary to be included in the ICU care practice and, consequently, includes this reality in both its documents and recommendations.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0035" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors’ contribution</span><p id="par0040" class="elsevierStylePara elsevierViewall">All authors have contributed to the conception and drafting of this letter.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Authors’ contribution" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Complejidad moral en el proceso de donación de órganos: un acto prudencial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L. Oteiza Lopez" 1 => "O. Elía Mañu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medin.2024.04.05" "Revista" => array:5 [ "tituloSerie" => "Med Intensiva" "fecha" => "2024" "volumen" => "48" "paginaInicial" => "555" "paginaFinal" => "556" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intensive Care Medicine: the cornerstone of the donation process in Spain" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D. Daga Ruiz" 1 => "J.J. Egea Guerrero" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medin.2019.04.004" "Revista" => array:4 [ "tituloSerie" => "Med Intensiva" "fecha" => "2020" "volumen" => "44" "paginaInicial" => "61" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "What follows refractory cardiac arrest: death, extra-corporeal cardiopulmonary resuscitation (E-CPR), or uncontrolled donation after circulatory death?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.R. Manara" 1 => "B. Dominguez-Gil" 2 => "J.M. Pérez Villares" 3 => "J. Soar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.resuscitation.2016.08.028" "Revista" => array:5 [ "tituloSerie" => "Resuscitation" "fecha" => "2016" "volumen" => "108" "paginaInicial" => "A3" "paginaFinal" => "A5" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bioética en donación y trasplante de órganos" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.M. Pérez Villares" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Bio y Der" "fecha" => "2020" "volumen" => "48" "paginaInicial" => "95" "paginaFinal" => "109" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cuidados intensivos orientados a la donación de órganos. Recomendaciones ONT-SEMICYUC" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Escudero Augusto" 1 => "F. Martínez Soba" 2 => "B. de la Calle" 3 => "A. Pérez Blanco" 4 => "B. Estébanez" 5 => "J. Velasco" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medin.2019.09.018" "Revista" => array:5 [ "tituloSerie" => "Medicina Intensiva" "fecha" => "2021" "volumen" => "45" "paginaInicial" => "234" "paginaFinal" => "242" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735727/unassign/S2173572724002340/v1_202410170428/en/main.assets" "Apartado" => null "PDF" => "https://static.elsevier.es/multimedia/21735727/unassign/S2173572724002340/v1_202410170428/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572724002340?idApp=WMIE" ]
