CCTC Ethical and Legal Considerations 3 — Questions and Answers
Question 1: A potential living donor is found to have a previously unknown serious health condition during evaluation. What is the coordinator's primary ethical obligation?
- Maintain confidentiality and inform only the surgical team
- Disclose all findings to the donor and ensure they understand the implications for their own health (Correct answer)
- Proceed with donation if the recipient's need is life-threatening
- Refer the donor to their primary care physician without further discussion
Correct answer: Disclose all findings to the donor and ensure they understand the implications for their own health
The coordinator must ensure full disclosure to the donor because the incidental finding directly affects the donor's health and decision-making.
Question 2: Which principle underlies the prohibition on paying donors for organs in the United States?
- Non-maleficence, to prevent surgical harm to healthy individuals
- Justice, to prevent exploitation of economically vulnerable populations (Correct answer)
- Beneficence, to maximize the number of available organs
- Autonomy, to prevent donors from making uninformed decisions
Correct answer: Justice, to prevent exploitation of economically vulnerable populations
NOTA prohibits organ sales primarily to prevent exploitation of economically disadvantaged individuals who might donate under financial duress.
Question 3: A patient on the transplant waiting list is found to be non-compliant with follow-up appointments. Ethically, how should this factor into transplant candidacy decisions?
- Non-compliance should automatically result in removal from the waiting list
- Non-compliance is irrelevant because all listed candidates have equal rights to organs
- Non-compliance should be assessed in context and used as one factor in the overall evaluation (Correct answer)
- Only financial non-compliance should affect listing status
Correct answer: Non-compliance should be assessed in context and used as one factor in the overall evaluation
Non-compliance is a legitimate clinical concern affecting post-transplant outcomes, but must be assessed contextually and not used as a sole or punitive criterion.
Question 4: What is the legal status of an advance directive specifically authorizing organ donation in a patient who later presents as a potential donor?
- It is legally binding and eliminates the need for next-of-kin authorization in all states
- It is generally given legal weight under the UAGA as an anatomical gift declaration (Correct answer)
- It is advisory only and can be overridden by family members in all circumstances
- It applies only to tissues, not solid organs, under federal law
Correct answer: It is generally given legal weight under the UAGA as an anatomical gift declaration
Under the revised UAGA, a donor's documented anatomical gift declaration is legally binding and takes precedence over family objection.
Question 5: A coordinator learns that a recipient's family has offered a financial gift to the donor family after transplant. What is the appropriate response?
- Allow it as a personal matter between families with no clinical relevance
- Report the arrangement to the OPO, as it may constitute illegal valuable consideration (Correct answer)
- Advise the recipient family to give a smaller gift to avoid legal concerns
- Document the gift in the medical record and take no further action
Correct answer: Report the arrangement to the OPO, as it may constitute illegal valuable consideration
Post-donation financial transfers may constitute valuable consideration for organ donation, which is prohibited under NOTA.
Question 6: Which of the following scenarios best illustrates a conflict of interest for an OPO coordinator?
- A coordinator who also works part-time as a critical care nurse at the same hospital
- A coordinator whose spouse is on the transplant waiting list at the hospital where they work (Correct answer)
- A coordinator who previously received a transplant and now advocates for donation
- A coordinator who is friends with a transplant surgeon at their OPO's service area hospital
Correct answer: A coordinator whose spouse is on the transplant waiting list at the hospital where they work
A coordinator whose family member is a transplant candidate at their hospital has a direct conflict of interest affecting objectivity in allocation.
Question 7: A pediatric patient's parents refuse organ donation on religious grounds, but the patient (age 16) expressed a wish to donate. What ethical framework should guide the coordinator?
- The patient's expressed wishes take precedence because they are close to the age of majority
- Parents retain full legal authority, but the coordinator should document the patient's expressed wishes and facilitate ethics consultation (Correct answer)
- The transplant team should proceed with donation to honor the patient's autonomy
- The coordinator should contact the courts immediately to override parental authority
Correct answer: Parents retain full legal authority, but the coordinator should document the patient's expressed wishes and facilitate ethics consultation
Minors lack full legal capacity to authorize donation, but their expressed wishes are ethically significant and warrant ethics committee involvement.
CCTC Ethical and Legal Considerations 3
A potential living donor is found to have a previously unknown serious health condition during evaluation.
What is the coordinator's primary ethical obligation?