Mary, a 23 year old female was involved in a head on collision that lead to massive head trauma and neurological injuries. She is not defined as brain dead, however, after 3 weeks in the Medical Intensive Care Unit and neurological consultations there is grave concern for the patient. The medial team has come back with a prognosis that âmeaningful recoveryâ is estimated to be less than 1%. At this point it appears that Mary would remain in a non-responsive (vegetative) state.
During this entire ordeal, Maryâs religious parents have been by her side and keeping track of everything going on. After consultation with Maryâs doctor and their priest, who is currently present for support, they decide it is time to remove Mary from tube feedings and off the ventilator. The parents feel that it is now âGodâs will.â Later that day, while the priest is present and with family surrounding, they remove life support.
In preparation, the Medical Intensive Care Unit nurse notified the Organ Procurement Organization (OPO) to be on standby, with the expectation that soon after extubation, death would soon follow. Mary was always thinking of others and even though she never signed up with the online stated done registry, her driverâs license showed she was an organ donor represented by a âheartâ on the front. Mary was carefree and did not have any healthcare directives but her driverâs license was enough to be considered a âfirst person consent.â
However, there is an issue. When the OPO rep arrives to discuss this with the family and explain that Mary had wishes to donate her organs, the parents are taken aback and upset at the suggestion. They explain that this was never discussed as a family and that they would not allow this to occur.
Even though Mary is not brain dead she qualifies as a donor under the hospitalâs âDonation after Cardiac Deathâ protocol. In addition, this would be in accordance with the stateâs newly revised âUniform Anatomical Gift Actâ which states that, âin the absence of an express, contrary indication by the donor, a person other than the donor is barred from making, amending, or revoking an anatomical gift of a donorâs body or a part if the donor made an anatomical gift.
The OPO rep goes to the attending physician and explains the interaction with Maryâs parents. They discuss hospital policies and state law, which is on their side. They also begin examination of Mary for preparation for possible donation. Soon after Maryâs parents come looking for the doctor and an explanation as to why Mary has not been removed from the machines and âlet God take over.â
Question 1) What should happen next? On what ethical and moral grounds? What about the law?
