Moral complexity in the organ donation process: The satisfaction of a job well done

Pérez-Villares, José Miguel; Lara-Rosales, Ramón; Fernández-Carmona, Alberto; Iglesias-Santiago, Alberto

doi:10.1016/j.medine.2024.07.014

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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" => "Letter to the Editor" "titulo" => "Moral complexity in the organ donation process: The satisfaction of a job well done" "tieneTextoCompleto" => true "saludo" => "Dear Editor:" "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "José Miguel Pérez-Villares, Ramón Lara-Rosales, Alberto Fernández-Carmona, Alberto Iglesias-Santiago" "autores" => array:4 [ 0 => array:4 [ "nombre" => "José Miguel" "apellidos" => "Pérez-Villares" "email" => array:1 [ 0 => "josem.perez.villares.sspa@juntadeandalucia.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Ramón" "apellidos" => "Lara-Rosales" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Alberto" "apellidos" => "Fernández-Carmona" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Alberto" "apellidos" => "Iglesias-Santiago" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Intensiva, Hospital Universitario Virgen de las Nieves, Sectorial de Trasplantes de Granada, Granada, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Medicina Intensiva, Intrahospitalario de Trasplantes, Hospital Universitario Virgen de las Nieves, Granada, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Complejidad moral en el proceso de donación de órganos: la satisfacción del trabajo bien hecho" ] ] "textoCompleto" => "Dying constitutes the final act in the personal biography of every human being and the former cannot be separated from the latter as something detached from it. A dignified life requires a dignified death, and out of respect for the patient's dignity, it is up to them (or their legal representatives) to choose how and under what circumstances they wish to die.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> Respecting the dignity of those who are in the process of dying means allowing them to choose the possibility of donating their organs, respecting their autonomy and freedom to manage their own biography according to their values. On the contrary, not offering the possibility of donation to a patient based on compassionate arguments is to adopt a paternalistic attitude that deviates from what the doctor-patient relationship should be.Donation-oriented intensive care programs (DOICP) respect the principle of autonomy, as they allow the patient's will to be incorporated into their care process, including instructions regarding the fate of their organs and/or tissues, and considering the moral values and principles that have shaped their life project. Regarding the family of the potential donor, donation can provide comfort in the face of loss and an opportunity to express values, such as solidarity and social commitment. For patients awaiting transplantation, by enabling organ donation, DOICPs help improve their survival and quality of life.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> Recognizing our patients’ principle of autonomy and respecting their right to be donors is not a process of reducing the person to a mere "object" or "diminishing the integrity of such person." Organ donation is a comprehensive part of end-of-life care. Therefore, our patients' right to donate must be accompanied by the obligation of health care professionals to present this option in all possible scenarios.For the "emotional cost" of our work as intensivists, if we are not confident in our ability to effectively manage the ethical and professional responsibilities associated with the care of potential donors at the intensive care unit (ICU) setting, we should perhaps prudently consider this matter before working in a specialty where such challenges are so common.<a class="elsevierStyleCrossRef" href="#bib0015">3</a>From an ethics of responsibility, what is fragile makes us responsible. When the fragile is a human being, they are entrusted to our care, delivered to our custody, and we are responsible for them. The professional's responsibility extends to managing the dying process of patients, which is also served by the ICU.<a class="elsevierStyleCrossRef" href="#bib0020">4</a> DOICPs allow the patient to manage their life trajectory, including the right to chart their own course toward death.We must remember that each patient on the waiting list, for whom transplantation is the only way to improve their survival and quality of life, is the responsibility of all health care professionals, including intensive care specialists.<a class="elsevierStyleCrossRef" href="#bib0025">5</a>FundingNone declared.Conflicts of interestNone declared." "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of interest" ] 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:1 [ "referenciaCompleta" => "Ley 2/2010, de 8 de abril, de Derechos y Garantías de la Dignidad de la Persona en el Proceso de la Muerte [Accessed May 2024]. Available from: <a target="_blank" href="https://www.juntadeandalucia.es/boja/2010/88/1">https://www.juntadeandalucia.es/boja/2010/88/1</a>." ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intensive care to facilitate organ donation. ONT-SEMICYUC recommendations" "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:6 [ "tituloSerie" => "Med Intensiva" "fecha" => "2021" "volumen" => "45" "paginaInicial" => "234" "paginaFinal" => "242" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31740045" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intensive Care admission aiming at organ donation as a duty of the intensivist: every organ, every time" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R.P. Moreno" 1 => "E. Almeida" 2 => "J.P. Sousa" 3 => "R.G. de Matos" 4 => "E. Sousa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-024-07464-x" "Revista" => array:6 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2024" "volumen" => "50" "paginaInicial" => "1183" "paginaFinal" => "1184" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/38713213" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intensive care admission aiming at organ donation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Pérez-Blanco" 1 => "A. Manara" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-024-07334-6" "Revista" => array:6 [ "tituloSerie" => "Pro Intensive Care Med" "fecha" => "2024" "volumen" => "50" "paginaInicial" => "437" "paginaFinal" => "439" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/38436724" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The right to become an organ and tissue donor at the end of life of critically ill patient" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D. Daga-Ruiz" 1 => "J.M. Perez-Villares" 2 => "L. Martín-Villén" 3 => "J.J. Egea-Guerrero" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medin.2018.11.005" "Revista" => array:6 [ "tituloSerie" => "Med Intensiva (Engl Ed)" "fecha" => "2020" "volumen" => "44" "paginaInicial" => "59" "paginaFinal" => "60" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30665688" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735727/unassign/S2173572724002339/v1_202410250423/en/main.assets" "Apartado" => null "PDF" => "https://static.elsevier.es/multimedia/21735727/unassign/S2173572724002339/v1_202410250423/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572724002339?idApp=WMIE"]

ISSN: 2173-5727

Medicina Intensiva is the journal of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC), and has become the reference publication in Spanish in its field. Medicina Intensiva mainly publishes Original Articles, Reviews, Clinical Notes, Images in Intensive Medicine, and Information relevant to the specialty. All works go through a rigorous selection process.

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