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This scenario is similar to the case mentioned briefly earlier from the UCLA Medical Center Ethics Committee. In this case, the ethics committee allowed surrogate consent for IDD based upon both (a) a close relative (first cousin) needing a kidney who was a match with the patient, and (b) the patient’s previous character and values, which were thoroughly demonstrated by the family to be significantly altruistic (e.g. the patient was a firefighter). This is despite the fact that neither the family nor friends had knowledge of the patient’s preferences and values regarding organ donation. More difficult scenarios would be whether to allow surrogate consent for IDD in this case if (a) the potential recipient was a stranger rather than a relative, or (b) the potential recipient was a relative, but there was no substantial evidence of the patient’s prior altruistic character, which treads into a moral gray zone. For more detail on this case, see: Brown-Saltzman, K., Diamant, A., Fineberg, I. C., Gritsch, H. A., Keane, M., Korenman, S., Lewis, M. et al., “Surrogate Consent for Living Related Organ Donation,” JAMA 291, no. 6 (2004): 728-731.Google Scholar

In cases where an incapacitated patient is a registered organ donor, it is ethically appropriate and justifiable for the transplant team to approach the patient’s surrogate decision-makers regarding the possibility of IDD. Given the patient’s past preferences for organ donation, this justifies the transplant team inquiring about the possibility of IDD in order to best respect the patient’s preferences and values. Of course, as already detailed above, a positive organ donor status does not necessarily justify pursuing IDD on its own, and more positive evidence is required to justifiably pursue IDD from an ethical perspective; however, a positive organ donor status does at least justify an inquiry regarding IDD to the surrogate decision-makers.Google Scholar