Deciding Who Gets Donor Organs: How Important Is Cognition?

MEDSCAPE | Pauline Anderson 


A new editorial tackles the thorny of question of whether cognitive competence should figure into the allocation of donor organs.

Scott D. Halpern, MD, PhD, and David Goldberg, MD, from the Departments of Medicine and Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, conclude that categorically denying access to deceased-donor organs solely on the basis of cognitive impairment is unacceptable.

In the commentary, published January 26 in the New England Journal of Medicine, Dr Halpern and Dr Goldberg recommend creating independent regional boards to adjudicate disputes surrounding which patients should get an available organ.

Such boards, they said, could include transplant physicians from various regions, ethicists, behavioral psychologists, social workers, and community representatives. The boards, they added, could issue recommendations and provide a much-needed source of impartiality.

As it stands now, there are few mechanisms to hold transplant centers, which ultimately determine who gets an organ, accountable for their decisions, Dr Halpern told Medscape Medical News.

Sole Discretion

Since governments have wisely decided not to "meddle" in the appropriate decisional authority given to independent transplant centers, these centers "have essentially had sole discretion regarding who to put on their waiting list for organs," said Dr Halpern. Continue reading


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