Home Ethical Issues Informed Consent Pre- vs. Post-Surgical Consent

Is pre-surgical consent preferable to post-surgical consent?

The timing of informed consent discussions should be carefully selected to ensure the potential donor does not feel coerced or pressured. Because potential donors are also typically surgical patients, the point of contact unavoidably happens at a difficult time for them. There are reasonable arguments for both pre-surgical and post-surgical consent to tissue donation. Repositories typically require one over the other; but both forms are practiced. In cases of post-surgical consent, targeted tissue is prepared as if it were to be banked, which can be costly if patient refusals are common.

Arguments for pre-surgical consent:

• Potential donors may be contacted at home by phone and away from the pressures of the hospital.
• Potential donors are not also making decisions based on their surgical results or dealing with the emotional impact if the surgery yields difficult news.
• Potential donors have not just undergone major surgery including the after-effects of anesthesia which may compromise their deliberation skills.
• Potential donors are not struggling with new pain and discomfort from the surgery and pain relief medications.

Arguments for post-surgical consent:

• Patients have their surgery behind them and so are in a less vulnerable position.
• The idea of excised tissue does not produce further surgery-related anxiety since their surgery is over.
• Since the decision follows their surgery, it cannot affect the surgeon performing their surgery.

Data on patient attitudes and decision-making capabilities pre-surgery and post-surgery would be helpful in supporting one position over the other in this matter. Patients differ as to whether the stress (and their emotional vulnerability) is greater before or after surgery. In addition, there is no data assessing the effects of anesthesia on patients' decision-making skills in the hours and early days of their recovery from surgery.