Editorial: Post-transplant contact a tricky ethical dilemma

The B.C. Transplant Society has embarked on a delicate, some might say fraught, research study. The question to be answered is whether it is ethically appropriate to allow organ donors, or their families, to be in contact with young recipients of those organs.

Since transplants began, for reasons of privacy, there have been strict limits around any contact between donors and recipients, or their families. When organs are donated, secrecy is preserved as to the identity of the recipient.

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There are good reasons for this. The families of deceased donors are understandably distraught.

They may wish to keep alive the memory of their loved one by contacting the recipient and establishing some form of relationship.

In 2018, members of the Humboldt Bronco junior hockey team in Saskatchewan were involved in a crash when their bus collided with a semi truck. Sixteen people died, most of them team members.

The mother of one of the players, 21-year-old Logan Boulet, gave voice to this sentiment when she told reporters she would give anything to hear her son’s heartbeat again. “I would love to meet the heart recipient and just to hear Logan’s heart again. It’s just having that mutual respect and that love for Logan and what he gave,” Bernadine Boulet said.

On the other hand, the recipient family, while grateful for the gift of life, may feel that brings too much grief into their lives.

In 2019, B.C. Transplant relaxed the rules somewhat to allow donor families to contact adult recipients if the latter agree. The process followed is that the donor family calls the society and asks if staff at the agency will inquire whether the recipients are willing to meet.

That request is put on hold until the recipient family independently also ask for a contact. Both parties must request a meeting before the Transplant Society will connect them.

If a meeting is agreed, each party can lay down guidelines on the kind of contact they would be comfortable with. This can be anything from a single written letter, to repeat letters or emails, or in some cases face-to-face get-togethers. Over the past two years, the society has arranged 10 of these meetings.

It’s easy to see how difficult these arrangements can become, however. The recipient family is, naturally, both grateful, and understanding of the trauma the donor’s family have been through.

They are, in that respect, vulnerable to ever- broadening degrees of contact. What if the donor family want to celebrate, with the recipient, yearly anniversaries of their loved one’s death?

It may seem callous to refuse. Is not there an obligation to be met? This is the very definition of a moral dilemma.

And that dilemma gains potency when contact is proposed with young recipients who may not fully understand what is at stake.

Is it really practical to expect five-year-olds, for example, to give informed consent to a relationship far beyond their experience or comprehension? The child may agree without foreseeing the emotional complications that could arise.

Why not wait until the child grows up and can make an adult decision?

And yet the donor family might desperately wish a degree of contact, as a means of relieving some of their grief. Telling them that years must pass before the question may be raised is a form of injury in itself.

Is it asking too much to let them share the joy their loved one’s gift of life has brought?

B.C. Transplant will spend the next year interviewing young recipients and their families, to see if there is a way forward. Staff are fully aware of the ethical challenges involved.

But this is an enormously delicate balance to strive for. The wisdom of Solomon will be needed to find it.

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