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Indian Journal of Medical Sciences, Vol. 58, No. 10, October, 2004, pp. 444 Letter To Editor Organ donation in mental retardation: A clinical dilemma Malhotra S, Balhara YPS, Varghese ST Department of Psychiatry and National Drug Dependence Treatment Centre, Centre for Behavioral Sciences, All India Institute of Medical Sciences, AIIMS, New Delhi - 110029 Code Number: ms04075 Sir, As the Hippocratic Oath stipulates, an informed consent is a must before any health care intervention. The basic tenets of informed consent are based on the elements of information, decisional capacity and voluntarism. An individual′s decision to give or withhold consent cannot be considered valid unless he or she has the capacity to make that decision. We were placed in an ethical dilemma when a mentally challenged lady was referred to us for assessment of giving consent to donate her kidney. She was the only HLA match available and was willing to donate her kidney and after counseling she had a reasonable understanding of the procedure that was planned. Her IQ score ranged 54-60. For the clinicians it raises many controversial but pertinent questions like, is she competent enough to understand the complexities of the issue? In order to assess her competence in this regard what all criteria need to be looked upon? Any decision on the part of the clinician should be ethically sound and for the beneficence of the patient. According to a recent Consensus Statement on Live Organ Donors "the person giving consent for transplant should be competent, willing to donate, free from coercion, medically and psychosocially suitable and fully informed of the risks, benefits and alternative treatment available to the recipient".[1] The consensus demands that the informed consent should be based on full understanding, disclosure and should be voluntary, based on the educational background of the donor. According to the guideline the donor should have psychosocial suitability for the transplant programme and active psychosis, severe mental illness precludes a person from donation. The donor should be evaluated for guilt, depression, substance abuse, coping skills. The presence of a psychosocial problem should not automatically exclude a person from being a donor but should prompt more intervention and discussion into these areas.[1] There is no mention of mentally retarded individuals in this guideline. In India neither the Organ Transplant Act, 1994 nor the Mental Health Act, 1987 provide any light. As the number of transplant procedures will increase, the ethical issues of the role of mentally retarded individuals in transplant programmes are of concern. There is a need to develop criteria and guidelines for assessment of mentally retarded individuals in transplant programme and to protect their rights. REFERENCES
Copyright 2004 - Indian Journal of Medical Sciences |
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