Patients, families, and organ donation: who should decide?

Although 69 to 75 percent of U.S. adults say they would be willing to become organ donors, half of the families that are asked to consider donating the organs of a deceased family member refuse to consent. This discrepancy is most noticeable when the refusal of a family conflicts with the known wishes of a patient. It is the practice of nearly all organ procurement organizations in the United States not to procure organs or tissue when families refuse, even if the patient's wishes have been documented. Recently, the Center for Organ Recovery and Education (CORE) adopted a controversial policy of acting on the documented wishes of individuals to donate, independent of family consent. An examination of the moral and political issues raised by this policy lead to the conclusion that the CORE policy is not only justified, but morally required.