Journal of Bioethical Inquiry

, Volume 6, Issue 1, pp 123–128 | Cite as

Organ Donation: Who Should Decide?—A Canadian Perspective

  • Jeffrey Conyers KirbyEmail author


This paper examines an under-explored issue in organ donation: whose decision making authority should be privileged posthumously in the context of known, explicit consent for donation? Current practices in Canada support the family as the ultimate decision maker, despite the existence of legislative support in many Canadian provinces for the potential donor as legitimate decision maker. Arguments for and against privileging the family and the potential donor are identified. Informing the question of “who should decide” are considerations of individual and relational autonomy, distributive and social justice, personhood, and arguments “from distress”. Tensions and competing obligations emerge from an exploration of these considerations that call for further, inclusive dialogue and deliberation on this important organ donation issue.


Bioethics (discipline) Organ donation (topic area) Decision maker Individual vs. relational autonomy Justice 


  1. Abadie, A., and S. Gay. 2005. The impact of presumed legislation on cadaveric organ donation: a cross country study. KSG Working Paper No. RWP04-024:1–26.Google Scholar
  2. Canadian Council for Donation and Transplantation. 2002. Awareness, knowledge and advertising recall. Health Canada.Google Scholar
  3. Daniels, N. 1980. Justice and health care. In Health care ethics: An introduction, ed. D. VanDeVeer, 290–325. Philadelphia: PA: Temple University Press.Google Scholar
  4. Giles, S. 2005. An antidote to the emerging two tier organ donation in Canada: The public cadaveric organ donation program. Journal of Medical Ethics 31: 188–191. doi: 10.1136/jme.2003.002931.PubMedCrossRefGoogle Scholar
  5. Gill, J. 2005. Preliminary statistics on organ donation, transplantation and waiting list. Canadian Organ Replacement Register Preliminary Report. Canadian Institute for Health Information.Google Scholar
  6. Giordano, S. 2005. Is the body a republic. Journal of Medical Ethics 31: 470–475. doi: 10.1136/jme.2004.009944.PubMedCrossRefGoogle Scholar
  7. Government of Nova Scotia. 1989. The Human Tissue Gift Act. Statute, 5(1).Google Scholar
  8. Hardwig, J. 2003. The problem of proxies with interests of their own. The Journal of Clinical Ethics 4: 20–27.Google Scholar
  9. Klassen, A., and D. Klassen. 1996. Who are the donors in organ donation? The family’s perspective in mandated choice. Annals of Internal Medicine 125: 70–73.PubMedGoogle Scholar
  10. Knoll, G., and J. Mahoney. 2003. Non-heart beating organ donation in Canada: Time to proceed?Canadian Medical Association Journal169: 302.PubMedGoogle Scholar
  11. May, T., M. Aulisio, and M. DeVita. 2000. Patients, families and organ donation: Who should decide. The Milbank Quarterly 78: 323–336. doi: 10.1111/1468-0009.00172.PubMedCrossRefGoogle Scholar
  12. Sherwin, S. 1998. A relational approach to autonomy in health care. In The politics of women’s health: Exploring agency and autonomy, ed. Susan Sherwin, 19–47. Philadelphia: Temple University Press.Google Scholar
  13. Young, I. 1980. Justice and the politics of difference. Princeton: Princeton University Press.Google Scholar
  14. Wilkinson, T. 2007. Individual and family decisions about organ donation. Journal of Applied Philosophy 24: 26–40.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2009

Authors and Affiliations

  1. 1.Department of Bioethics, Faculty of MedicineDalhousie UniversityHalifaxCanada

Personalised recommendations