Teaching transplantation ethics to final-year medical students
Article first published online: 20 OCT 2009
© Blackwell Publishing Ltd 2009
Volume 43, Issue 11, pages 1109–1110, November 2009
How to Cite
Vernon, B., Fulton, B., Hamilton, L. and Robson, L. (2009), Teaching transplantation ethics to final-year medical students. Medical Education, 43: 1109–1110. doi: 10.1111/j.1365-2923.2009.03500.x
- Issue published online: 20 OCT 2009
- Article first published online: 20 OCT 2009
Context and setting A 3-week course entitled ‘Preparation for Practice’ was introduced for final-year students in 2005 as part of a new curriculum delivered in four base units. Each teaches to common learning outcomes, one of which is: ‘Develop knowledge, understanding and an ability to apply the principles of medical ethics in the ethical considerations relevant to organ donation.’
Why the idea was necessary Feedback from students showed they had not achieved this outcome in our base unit in 2007.
What was done A transplant surgeon, an intensive care unit (ITU) consultant and a transplant coordinator were recruited by the ethicist to design a session to address this deficit. A 3-hour lecture theatre slot and a 2-hour seminar for student group preparation were timetabled.
The ethicist introduced the session with a TurningPoint presentation which required the students to answer 16 questions testing their knowledge and opinions. These included:
- 1Why carry out brain stem death tests?
- 2Should the positive benefits of transplants be explained to families?
- 3If you were responsible for the allocation of organs, would you consider age, length of wait or cause of disease in your selection of candidates? (76%, 71% and 59% of students answered in the affirmative to these items, respectively.)
- 4If an individual who has refused to donate his or her organs should need a transplant, should he or she have access to one? (65% said yes.)
We also discovered that 60% of the students had discussed their own organ donation wishes after their death with their next of kin, 51% knew what their mother would want in the event of her own death and 52% were on the organ transplant register.
Each of eight groups of 11 to 13 students prepared a 15-minute presentation. There were four topics:
- 1Brain death criteria in the UK, Denmark and the USA: who’s got it right?
- 2Why some families refuse to allow organ donation and why some clinicians do not ask.
- 3A debate on the motion: ‘This house believes that the UK should adopt a system where consent for organ donation after death is presumed unless there is evidence that the potential donor had objected.’ (67% agreed.)
- 4Suggestions for alternative ways of increasing the supply of organs.
One group was selected to present each topic and the four teachers commented on the presentations. The ITU consultant then explained what happens at brain death and the transplant surgeon described his experience of a minor’s transplant refusal. The ITU consultant used students to role-play a request for consent for organ donation from relatives. The transplant coordinator used this simulation to explain the process of eliciting family consent.
Evaluation of results and impact Ten days later, TurningPoint was used to evaluate the session. We asked whether students would scrap the session, repeat the session in its current format, or change it. Responses were 5%, 80% and 15%, respectively. Online free text comments submitted later included: ‘The transplant session was excellent and it was great to meet all the team members involved in organ donation’; ‘Transplantation morning very well organised and engaging’, and the more sobering ‘I think it’s pointless making all the groups prepare a presentation for transplantation if only half will present’.