Ethical and forensic psychiatric contributions to living organ donors’ evaluation

摘要

Summary:Introduction: evaluation of living organ, tissue or cell donors is required in order to establish both theexistence and the capacity to express a free and informed consent on the donation for transplantation process.Different views of autonomy might influence the decision if a donor’s offer is ethically acceptable. Acceptabilityof a prospective donor might be influenced by cultural, legal and social situations in different countries.Evaluation of the capacity to donate is in Romania the task of a joint forensic medicine and psychiatriccommission.Method: we analyze the case of a young man with mild mental retardation who was willing to donate akidney to distant relative and in whom a rejection decision was finally made by the ethics commission based on aforensic expert opinion. We investigated elements of mental status examination, the process of understanding therecipient’s illness and transplantation outcomes, aspects of psychosocial stability, affective relationship with therecipient, education, social and familial insertion.Results: based on our case analysis and review of the literature we aimed to elaborate a semi-structuredinterview as tool of assessment of living donors consent and capacity to donate an organ for transplantation. Wepropose the following items: understanding of the recipient’s illness, understanding of the transplantationprocess (including risks), decision to donate development, knowledge of post-donation health risks, right toreconsider. Each item contains a range of questions and finally a scoring is established by the interviewer.Moreover, a context of psychiatric history, personality style and mental status examination should complete theinterview.Conclusions: the donor’s autonomous and voluntary decision is a necessary prerequisite for allowing aphysician to hurt one person in order to help another. Ethical principles must be completed with medico-legalpsychiatric standards for settle some cases in the "grey zone".