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Dear Dave: As you say, in the past, the patient have had very little discussion regarding the quality of the donated organ found for them. The reason was that the teams involved in procurement & transplantation always choose the optimal organs!. With larger expertise and the dramatical growing in waiting list, we expanded the criteria for organ donation for “suboptimal” organs.
In this point, I agree the patient and family need to be a fully informed part of their team. However, I think the selection must be done previosly. I mean: The medical team has to discuss the posibility the patient will recieve an organ for a marginal donnor and make a separate list with whom will agree to receive that kind of organs. It might be a previous discution because, when the organ appears, nor the patient, either the family, is always enough clear to make such a decision.
Of course, if you give a choise betwen an optimal or suboptimal organ, patients would not choose a sub-optimal organ for themselves. But you have to think that the real choise is betwen Tx. vs. NO Tx.
Best regards
Luis