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Organ Donation: Medicine Interview Ethics

Organ Donation: Medicine Interview Ethics

Updated on: December 3, 2023
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Written By Dr Ollie

Every article is fact-checked by a medical professional. However, inaccuracies may still persist.

Organ donation is a topic that frequently comes up in medical school interviews.

It’s perfect for interviewers to get you to think about the laws, clinical judgements and ethical dilemmas that can all surround the subject.

Organ donation is also a topic that everyone can have an opinion on- and as with nearly any ethical dilemma, there’s no one correct answer.

In this article, I’m going to look at the different systems that can be used to govern organ donation, their pros and cons, which the UK uses and finally finish with some questions that commonly crop up at medical school interviews regarding organ donation.

This means that once you’ve read the article you should feel fully prepared and confident to discuss the topic in depth at any upcoming interviews.

Learn about other medical ethics topics that almost always get asked about here.

How Do Organ Transplants Work?

To start with, I thought I’d cover just a bit of background knowledge regarding organ donation, before diving into the opposing ethical arguments.

Organ transplantation is simply when an organ from one body is taken out and placed into another person’s body in order to replace missing or damaged tissue.

Organs that can be transplanted include everything from kidneys to hearts to the uterus (womb).

The donor can either be living, dead or brain-dead and organs can normally be harvested up to 24 hours after the last heartbeat.

Transplant medicine is incredibly complex and there’s a lot more to it than just finding a donor of a similar size and sex to make a donation.

Transplant surgeries are generally big, complicated procedures that have a high risk of complication and failure.

Stopping the recipient’s body from rejecting the new organ can take a lifetime of immunosuppressive drugs and even still transplants can fail for unclear reasons.

The Different Systems For Organ Donation

The two main systems we consider when thinking about the laws and ethics regarding organ donation in the UK are the opt-in and opt-out systems.

Opt-in means that people by default aren’t signed up to donate organs. If you die and haven’t explicitly said that you want to become an organ donor, it’s presumed that you don’t consent to have your organs taken.

The opt-out system is essentially the opposite. Everyone is presumed to consent to donate any viable organs upon their death unless they explicitly say otherwise (opting out).

Organ Donation Ethics Pixel Infographic

With the opt-out system, you can also have both a hard opt-out or a soft opt-out.

A soft opt-out means that even if someone dies and hasn’t explicitly said they don’t want to become a donor, their family can have the final say on whether or not their organs can be donated.

If the family doesn’t want them to be taken then they won’t.

A hard opt-out system doesn’t allow for this. If someone hasn’t explicitly opted out of organ donation their organs may be taken even if their living family members object.

Opt-In Vs Opt-Out Systems

Considering how different the two systems are, each undoubtedly has its own advantages and disadvantages.

If we consider the opt-in system first, arguments in favour of it include:

  • Autonomy: Patients have their autonomy respected to a greater extent with the opt-in system compared to the opt-out system. In the opt-in system, patients have to give their informed consent for them to become a donor rather than it being presumed they’re okay with it. It’s possible some people simply wouldn’t know about the system in place, or would forget to complete the correct paperwork, so would end up having their organs harvested when that’s not what they would have wanted.
  • Education: The opt-in system does generally have a lower uptake than the opt-out system. However, this could be combatted with education and publicity drives to the general public, rather than just switching the system. More people would likely sign up if they were more aware of the issues and waiting lists surrounding organ donation.
  • Respect: There are many people who see removing organs or tissues from the dead as highly disrespectful or that it contradicts their religious beliefs. Other people just don’t like the idea of someone walking around with their organs in them after they’ve died! The opt-in system is more likely to ensure that only people who have specifically said they want to partake in the process have their organs taken- rather than using any and everyone who hasn’t opted out.

Equally, however, there are some very compelling arguments in favour of the opt-out system:

  • Increased uptake: Arguably, the main benefit of the opt-out system over the opt-in system is that it leads to more organs being donated. The opt-out system means that everyone who was on the fence or wasn’t bothered enough to complete the correct paperwork can have their organs donated rather than not. With a huge shortage of organs in the system and ever-increasing waiting lists, anything that increases the number of organs becoming available will have a massive positive impact on patients waiting for a donor.
  • Relief of suffering: There’s an argument to be made that we shouldn’t prioritise the apathy of the dead over the suffering of the living. If someone hasn’t taken the necessary steps to opt out of donating their organs while they were alive, real, suffering patients who need organ donors should get the necessary treatment they require. The impact an organ can have on a patient who needs one is absolutely life-changing compared to the arguably minimal effect on the dead person.
  • Normalisation: Many people feel that organ donation needs to become more normalised for it to become more widespread. With the opt-out system, it’s ‘normal’ for people to donate their organs so it isn’t seen as a thing you have to go out of your way to make happen. If it becomes the default setting then people are more likely to have their views moulded by this state of affairs and so are more likely to support donating their organs rather than being seen as going against the grain.

What Are The Current UK Laws Governing Organ Donations?

The UK traditionally operated under an opt-in system. Meaning if you wanted to become an organ donor then you had to submit a form clearly stating your wishes.

However, Wales became the first UK nation to move to an opt-out system in December 2015.

Wales introduced a soft opt-out system which resulted in donation statistics jumping from 58% in 2015 to 77% just a few years later.

Following the success of Wales’ new organ donation system, England followed suit in the spring of 2020.

An organ transplant operation underway

England currently also operates with a soft opt-out system in which people over the age of 18 are automatically added to the Organ Donor Register and must actively withdraw if they want to be removed.

In the spring of 2021, Scotland joined England and Wales leaving only Northern Ireland with an opt-in system currently in place for organ donation.

Even though by default people are added to the Organ Donor Register, there are still some excluded groups that don’t become eligible for donation.

For England, these include:

  • People under the age of 18
  • People who lack the mental capacity to evaluate the rules regarding organ donation
  • Temporary residents and those not living in England voluntarily
  • People who have lived in England for less than 12 months before their death

How To Decide Who Gets A Transplant

One of the most common ethical dilemmas regarding organ donation revolves around determining which patient should receive the tissue.

This can unfortunately very much reflect reality with a large number of people requiring a transplant with comparatively few organs that become available every year.

A classic medicine interview scenario could involve presenting you with two patients, each with their own backstory and conditions, and asking you to decide who should get a single kidney/liver/lung etc.

There’s rarely one ‘correct’ answer, but rather the interviewer is often looking to understand your reasoning and the framework you’re using to make the decision.

Each scenario will be different, but there are a few common themes that you can consider if you’re trying to evaluate who should get the donation:

  • Clinical care: As I mentioned earlier, organ donation is an incredibly complex, multifaceted science. Not every organ is suitable for every patient. If clinically one patient is far more likely to benefit from the organ, while another is far more likely to immunologically reject it, the patient with the greatest clinical suitability should be chosen.
  • Quality Adjusted Life Years: Quality-adjusted life years (or QALYs) are how many extra healthy years a patient will benefit from if they receive treatment. A figure of 1.0 is used to represent a perfectly healthy year, 0.8 for a mostly healthy year, 0.2 for a year in very poor health etc. For example, a teenager receiving a heart transplant for a hereditary condition could go on to live 60 more perfectly healthy years (QALY of 60). However, an alcoholic who continues drinking could go on to live 8 years in moderate (0.5) health after a liver transplant (QALY of 4). This is one way to estimate and compare the benefits of different patients receiving treatment.
  • Consequences: The consequences of a patient not receiving a transplant may not always be equal. A patient with end-stage renal failure will eventually die if they don’t receive a transplant. However, a patient with one damaged kidney and one healthy kidney will likely be completely fine if they don’t have their damaged one replaced. It can be helpful to take this view to consider what might happen if each patient doesn’t get what they want.
  • Postoperative care: This consideration is all about how the patient is going to care for their newly transplanted organ once they’ve received it. An alcoholic who continues drinking will quickly ruin a new liver. A smoker who continues smoking will quickly damage a new lung. If a patient isn’t able to stick to their postoperative medication regime their body will quickly reject the foreign tissue. An organ transplant isn’t completed at the point the operation is finished but rather continues for years down the line. Thinking about how a recipient would treat their newly transplanted organ can help you decide who would be a more worthy patient.

There are literally hundreds more things you can consider, from if a patient has dependents, their age, activity levels, aspirations and achievements, but ultimately to impress your interviewer you just have to make a reasoned, logical clinical judgement using the information you have available.

Transplants For Self-Inflicted Disease

Another classic dilemma that’s thrown at medicine applicants is that of a patient needing a transplant who ‘did this to themselves.’

This might be an alcoholic who loves to drink, a smoker who got lung cancer or even someone who refused a vaccine and subsequently became seriously ill.

A homeless man on the streets

Although intuitively most people lean towards morally punishing these sorts of patients by hypothetically choosing another patient to give a donor’s organ to, I think you have to be careful where you draw the line.

Ultimately, cardiovascular disease can directly result from obesity and an unhealthy diet. But do we refuse heart attack treatments to fat people?

An alcoholic may be an alcoholic because they were sexually abused as a child. Should we still punish them for continuing to drink even if they have a ‘valid’ reason for how they’re acting?

Again, there’s no right answer but they’re certainly considerations you could pepper into an interview discussion.

You do also however have to be careful not to go too far the other way as there’s no point in giving a new liver to an alcoholic who’s continuing to drink heavily.

Should The UK Allow Organs To Be Sold?

It is currently illegal to buy or sell organs in the UK under the Human Tissue Act of 2004, which governs the use, removal, and transplantation of organs and tissues.

A question that may be posed to you at a medicine interview however is whether this act should be reversed.

If it were legal to buy and sell organs:

  • The number of organs available would drastically increase. There is objectively a significant shortage of organs on the market today that leads to hundreds of people dying on the waiting list every year. If it were legal to sell organs there would presumably be a significant market that could move to meet this unmet demand.
  • The black market would diminish. One of the reasons that there’s a significant black market for organs and organ trafficking is that selling organs is illegal in most countries. People turning to the black market have unsafe, unregulated procedures, sometimes against their will. Legalising the sale of organs would bring this market into regulated healthcare facilities.

But, there would be plenty of serious implications:

  • People may be forced to sell their organs due to financial pressures when they don’t really want to. Selling a kidney to pay off debt could have life-changing consequences for the donor long after the debt would be have been paid off and forgotten.
  • If the sale of organs becomes more accessible there’s an increased incentive for people to forcibly harvest organs from others against their will. Illegal organ farms could be set up with gangs drugging and surgically removing organs from people for profit.

Organ Donation Interview Questions

Finally, I’ve just written a few example medicine interview questions here for you to test your knowledge and ethical reasoning regarding organ transplantation:

  1. What implications could the widespread use of laboratory-grown organs have?
  2. What are your thoughts on the ethics of xenotransplantation? (Transplantation of organs from animals to humans.)
  3. How do you prioritise the ethical principles of autonomy, beneficence, and justice in the context of organ transplantation and allocation?
  4. Can you discuss the concept of “opt-out” versus “opt-in” systems for organ donation and the ethical considerations surrounding these approaches?
  5. What are some of the potential conflicts of interest that can arise during the process of organ donation? These could be from patients, family members or healthcare professionals.

Final Thoughts

Organ donation can be a tricky topic to discuss if you’re unsure of the rules and regulations governing it in the UK.

However, you should now be clued up and up-to-date on exactly what doctors and the public can and can’t do.

If organ transplantation is brought up at your medical school interview it should now be an opportunity for you to show off your depth of knowledge on the subject as you deftly debate its ethical considerations. 

About the author
After studying medicine at the University of Leicester, Dr Ollie now works as a junior doctor in London. His interests include medical education and expedition medicine, as well as having a strong belief in the importance of widening access to medicine.